A. A. Okolo

Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels

Background:Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden.Methods:Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010.Results:Twenty-four million (18% of 134 million live births ≥32 wk gestational age from 184 countries; uncertainty range: 23–26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had either Rh disease (373,300; uncertainty range: 271,800–477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000–131,000), with a 24% risk for death (114,100; uncertainty range: 59,700–172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments.Conclusion:Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries.

The hearing profile of Nigerian school children

The paucity of up-to-date and representative epidemiological data on hearing disorders in Nigeria has been observed as undermining the effective advocacy of prevention initiatives. This study attempts to address this problem by evaluating the prevalence and pattern of hearing impairment in school entrants. Parental interviews, otoscopy, pure-tone audiometric screening (frequency 0.5-4 kHz) and tympanometric examinations were conducted for a representative sample of 359 school children in an inner city area of Lagos. The prevalence of hearing loss was 13.9%. Middle ear abnormalities were noted in 20.9% of the study population, of which 18.7% were reported with otitis media with effusion. Impacted cerumen, documented in 189 children (52.6%), was the most common disorder. It showed significant association with hearing loss (P<0.001) and school performance (P<0.01). Tympanic membrane abnormalities were observed in 144 (40.1%) children. Of these, 45 (31.3%) showed abnormal tympanograms while 28 (19.4%) reported hearing loss (P<0.05). The early detection and management of hearing problems is relatively rare, thus precluding the determination of possible aetiological factors for the observed abnormalities. Poor public awareness, dearth of relevant facilities and the lack of early screening programmes are major known contributory factors. The well established national immunisation programme offers a cost-effective platform within the primary health-care system for addressing the high prevalence of hearing abnormalities in school children.

Changing pattern of neonatal septicaemia in an African city

The pattern of neonatal septicaemia in a large cosmopolitan African city is presented. Comparison of microorganisms isolated in the present study when compared with the results of previous reports from the same institution, show an increase in the incidence of klebsiella and pseudomonas septicaemia. In contrast, Escherichia coli infection has decreased appreciably from an incidence of 56.8% to 14.3%. Staphylococcus aureus has remained the dominant Gram-positive pathogen over the last decade while group B streptococcal (GBS) disease was rarely encountered. A significant finding was the emergence of gentamicin-resistant strains of E. coli and proteus species during the past 5 years. The overall incidence of neonatal septicaemia was 5.6/1000 livebirths and the mortality rate was 30.6%.

Bacterial growth in expressed breast-milk

We determined the degree of bacterial contamination and the rate of bacterial growth in expressed breast-milk stored in a tropical environment with high ambient temperatures and humidity. Colostrum or mature milk obtained from mothers who were delivered preterm or at term was stored at room temperature (27-32 degrees C) and in a refrigerator (4 degrees C) over a 24-h period. Bacterial isolates represented normal skin flora. Our study showed that colostrum was more inhibitory than mature milk, and term colostrum more so than preterm colostrum. At room temperature, mature milk from term mothers could be stored for 6 h without a significant increase in bacterial counts. Term colostrum could be stored for 12 h without significant bacterial growth. Preterm milk could be stored for 4 hr. Our findings should be of practical value to lactating mothers without access to refrigerators.

Normal hematological values of the african neonate

SummaryA longitudinal study of normal hematological values of the newborn infant was undertaken in an effort to provide baseline data for assessing the African Neonate with hematological problems. There were 402 neonates, consisting of 304 full-term, 51 preterm and 47 post-term infants. The Hematocrit (Hct), Hemoglobin (Hb), Red Blood Cell Count (RBC), Reticulocyte count (Retic) and Nucleated Red Blood Cell Count (NRBC) were serially determined. The red cell indices, Mean corpuscular Hemoglobin (MCH), Mean Corpuscular volume (MCV) and Mean corpuscular Hemoglobin Concentration (MCHC) were calculated for each neonate. Our results showed that African neonates have lower hematological values than their North American and European counterparts. This was neither a reflection of an intrauterine anemia nor was it due to variables resulting from the timing of cord blood sampling. On the first day of life, the mean Hct was 45.4%; mean Hb was 15.46 gm/dl; and the RBC was 4.02×106 cells/mm2. The Retics, NRBC and other red blood cell indices do not differ from those of neonates reported from other parts of the world. We suggest therefore that the low hematological values of the African neonate may be intrinsic.

Sternal ossification in normal newborn infants.

The lateral chest radiographs of 200 Nigerian newborn infants, whose gestational age was estimated by the Dubowitz examination, were analysed for the pattern of ossification of sternal segments. The length of each visible centre was also measured. The manubrium was ossified in all infants over 35 weeks. All infants 37 weeks and above demonstrated ossification of the first and second mesosternal segments. Ten infants had ossification of the xiphisternum. The average number of ossified segments see in this study is more than previously reported amongst Caucasian infants. The length of each segment correlated better with birth weight than gestational age. Our findings indicate that any infant with two ossified sternal segments, including the manubrium, is at least 30 weeks and those with 3 and 4 segments 34 and 37 weeks gestation, respectively. There is no difference in the pattern of sternal ossification between the sexes.

Pepsin and its multiple forms in early life.

Pepsin and its multiple molecular forms have been studied in pre-term and post-term Nigerian infants. The levels of total enzyme activity and acidity were lower in the pre-term infants when compared to term and post-term infants. Resolutions of the various species by ion-exchange chromatography and electrophoresis revealed that the development of specific isoenzymes in term infants occurred towards the end of the neonatal period. Differential development of the enzyme and the isoenzyme in the neonatal period may have important clinical bearing on the subsequent pancreatic protease hydrolysis which may provide a basis for evaluating gastric capacity for nutritional management of these infants.

Urine examination findings in apparently healthy new school entrants in Jos, Nigeria

Background: Urinalysis as part of medical examination of fitness in school children is useful in detecting abnormalities that could identify early disease conditions. Objective: To describe the urine examination findings in apparently healthy newly enrolled primary school entrants in Jos – Plateau. Methods: Through a multistage stratified randomization procedure, six hundred and fifty apparently healthy pupils were selected to have a complete physical examination in the morning with mid-stream urine samples collection. The urine samples were examined for abnormalities using dipsticks. Results: Three hundred and one (301) were males and three hundred and forty-nine (349) were females, giving a male to female ratio of 0.9:1. Their ages ranged from 5 to 12 with a mean age of 6.6  1.31. Urinary abnormalities were present in sixty-three (9.6 percent) of the subjects with majority in the six to eight year range. Proteinuria was the commonest abnormality detected and this was found in 23 (3.5 percent) of the subjects. Urobilinogen was present in 12 (1.8 percent) of the subjects. This was significantly greater in male and private school subjects, P-value =0.03. Haematuria and nitrituria was present in ten (1.5 percent) subjects while eleven (1.7 percent) had bilirubinuria. Four (0.6 percent) subjects had ketones in their urine but none had glycosuria. Two pupils (0.2 percent) had both haematuria and proteinuria but no associated elevated blood pressure. Conclusion: Urine abnormalities are not an uncommon finding in new school entrants and it underscores the importance of urine examination in school children at the point of school entry.

Changes in serum lysosomal hydrolases in marasmus

The activities of several lysosomal hydrolases including beta-glucuronidase, acid phosphatase and hexosaminidase were compared in serum from 19 well-nourished subjects and 13 children (age 5--24 months) who were suffering from marasmus. The marasmic children exhibited growth retardation and muscle wastage but had normal serum protein values and absence of psychomotor retardation or oedema. Significant changes were observed in serum beta-glucuronidase and acid phosphatase activities. Compared to the control group, serum beta-glucuronidase (determined at pH 4.5 using the fluorogenic substrate, 4-methylumbelliferyl-beta-D-glucuronide) was 2.3-fold higher (p less than 0.001) in the marasmic children. In contrast, serum acid phosphatase values were approximately 50% lower (p less than 0.01) in the marasmic population. Serum hexosaminidase values in the two groups under study were not significantly different. Determination of the beta-glucuronidase to acid phosphatase ratio permitted effective discrimination (p less than 0.001) of serum from normal and protein-calorie malnourished children. The finding that the elevated value of the beta-glucuronidase : acid phosphatase ratio (0.64--1.37) decreased to within the normal range of values (0.10--0.43) after nutritional rehabilitation of several marasmic cases indicates that the determination of serum lysosomal hydrolases using fluorogenic substrates might provide a rapid and sensitive quantitative method for objectively evaluating the status of protein-calorie malnourished children and their responsiveness to nutritional therapy.

Malaria parasitaemia in neonates with predisposing risk factors for neonatal sepsis: report of six cases

In a study of neonatal malaria at the University of Benin Teaching Hospital, we documented the features of six neonates in an effort to highlight that the manifestations of malaria in the newborn cannot be readily distinguished from those of neonatal sepsis. Maternal peripartum fever, an important identifiable risk factor for neonatal sepsis, also featured prominently in the mothers of these babies. These mothers ingested pyrimethamine weekly in the course of their pregnancy. All six neonates were critically ill. Their cultures of blood, CSF and urine for bacterial pathogens yielded no growth and they were unresponsive to conventional antibiotics. The diagnosis of malaria should be considered, in spite of regular maternal ingestion of antimalarial prophylaxis with pyrimethamine, in critically ill neonates in malarious areas. All six neonates responded satisfactorily to oral doses of chloroquine. We therefore suggest that a blood film for malaria parasites be included in screening for neonatal sepsis as part of the initial work-up.