Amadou Lamine Fall

Insuffisance cardiaque sur cœur normal révélant une malformation artériole-veineuse complexe du membre inferieur chez un enfant: à propos d'une observation et revue de la littérature

Arteriovenous malformations (AVM) are congenital high-flow vascular defects. They are very rare in children. Diagnosis and treatment are often delayed due to their atypical place of occurrence and to their variable clinical manifestations. We report the case of a child treated at the National Centre Hospitalier Albert Royer Children, Dakar. A boy aged 9 years was referred from a health facility in rural areas for the treatment of heart failure. Admission clinical examination showed impaired general condition, global heart failure syndrome and voluminous right warm inguinocrural mass extended to the right abdominal wall (iliac fossa and right flank), with poorly defined limits. Auscultation of this mass showed a thrill and diffuse murmur. Cardiac ultrasound showed severe pulmonary arterial hypertension (PAH) with extensive impairement of the heart cavities, without cardiac structural involvement. The diagnosis of AVM was confirmed by doppler ultrasound of the mass complemented by angiography scan. They showed multiple arteriovenous fistulas within the mass. The diagnosis of complex stage IV AVM (according to Schöbinger classification) of the root of the right thigh was retained. Clinical treatment of heart failure was based on furosemide, spironolactone and captopril to obtain hemodynamic stabilization before possible surgical procedure. Arteriovenous malformations of the limbs, in particular of the proximal end of the lower limb in children are still largely unknown, hence frequent diagnostic errors and delays. Their evolution is unpredictable requiring early diagnosis and careful monitoring involving multidisciplinary interaction between pediatrics, surgeons and radiologists.

Evaluation of Malnutrition among Children Aged 2 to 60 Months Hospitalized in the Pediatric Services of Ziguinchor Hospital

Introduction: Malnutrition is a public health problem in the world and especially in developing countries. The prevalence of malnutrition at the national level does not reflect the situation in hospital. It is in this context that we assessed the nutritional status of children under 5 years old hospitalized pediatric services in the municipality of Ziguinchor. Material and methods: This was a prospective study that ran from June 1 to October 30, 2016. Included were children aged 2 to 60 months hospitalized in one of the two services. Children with esdato-ascetic syndrome were not included. Epidemiological, anthropometric data, and associated diagnosis were studied. Results: We included 114 children (70 boys and 44 girls). The average age was 21.9 months. Forty-two point one percent (42.1%) of infants <6 months were breastfed exclusively with breast milk. The weaning of children is done early in 55.3%. The mean age of mothers was 26.6 years. The socioeconomic level was low in 62.3% of cases. The prevalence of malnutrition averaged 35.5% for underweight; 32.9% for wasting and 32.0% for stunting. Acute respiratory infections (ARI) and acute gastroenteritis were the most common associated conditions. Mean hospital stay was 8 days ± 009. About two thirds of the patients (n=72) had a hospital stay of more than 7 days. Malnutrition was significantly associated with multiparity, low socioeconomic status, hospital stay of more than 7 days and infectious diseases. Conclusion: Infections and hospitalization lasting more than a week are factors that promote malnutrition in children under 5 years of age.

The effect of targeted wide age range SIAs in reducing measles incidence in the African Region

Periodic measles supplemental immunisation activities (SIAs) increase population immunity and thereby reduce the pool of accumulated susceptible children. They are typically conducted every 2 – 4 years, and most often target children up to five years of age. Between 2012 and 2015, after surveillance data indicated a shift in the epidemiological profile of measles towards older age groups, 11 countries were supported to conduct wide age range SIAs based on their local epidemiological patterns. Six other countries conducted SIAs with measles-rubella vaccines targeting ages 9 months to 14 years as an initial step of introducing rubella vaccine into the immunization program. In subsequent years, the incidence of confirmed measles dropped significantly in 13 of the 17 countries reviewed. The findings emphasize the importance of well-functioning surveillance systems, and the benefits of using of surveillance data to determine the specific target age-range for periodic SIAs to accelerate progress towards measles elimination.

Neonatal Obstetric Trauma in a Hospital in the Suburbs of Dakar, Senegal

Introduction: Neonatal obstetric traumas remain an important cause of morbidity-mortality. The objective of this study was to study obstetric traumatic lesions of the new-born in the paediatric department of the Centre hospitalier Roi Baudouin. Patients and method: This was a descriptive retrospective study of new-borns with obstetric trauma received at the Centre hospitalier Roi Baudouin’s paediatric ward over a 12-month period. The variables studied were maternal (age, parity, presentation, mode of delivery and place of delivery,) and neonatal (birth weight, type of lesion and diagnosis time). Results: Out of the 1426 new-borns received during the study period, 60 had trauma, a hospital frequency of 4.2%. The average age of new-borns for consultation was 8.85 days. The known and found contributory factors were: birth weight greater than 3500 g and the absence of cry at birth. Births were delivered by midwives (80%), the hospital was the main place of birth (61.7%). The main clinical presentations were: neonatal brachial plexus palsy (38.3%), fracture of the clavicle (33.3%) and caput succedaneum (13.3%). Conclusion: New-born obstetric trauma are relatively frequent at the Centre hospitalier Roi Baudouin The diagnosis is delayed due to a lack of proper examination of the new-born in the delivery room. Systematic examination of new-born at birth would be a reliable means for the detection and early management of this condition.

Syndrome hémolytique et urémique de l'enfant au Centre Hospitalier Universitaire (CHU) de Dakar: à propos de quatre observations

Hemolytic-uremic syndrome (HUS) is a common cause of organic acute renal failure (ARF) in children. It is a progressive complication of acute gastroenteritis (AGE), especially caused by Escherichia coli in children. This study aimed to describe the clinical, therapeutic and evolutionary aspects of this affection in four children. We collected four cases of HUS. The average age was 10,5 months (5-15mois), exclusively boys. Clinical examination revealed a hemolytic anemia (pallor and jaundice), oligoanuria and edematous syndrome (2 cases), arterial hypertension (1 patient), AGE associated with severe dehydration and hypovolemic shock (2 patients), consciousness disorders. ARF was found in all patients as well as thrombocytopenia and schizocytes smear. Direct Coombs test was negative. Hyperkalemia was found in 3 patients, of whom 1 with hyperkalemia level of more than 9.2 mmol/L, hyponatremia at 129 mmol/l (1 patient) and hypernatremia at 153 mmol/l (1 patient). HUS was secondary to pneumococcal pneumonia (1 patient) while AGE was secondary to E. coli (1 patient). The treatment was mainly symptomatic and included fluid restriction, transfusion of red cell concentrates, diuretics, peritoneal dialysis and hemodialysis. The evolution was marked by the onset of chronic renal failure (1 patient) after 6 months of follow-up and by recovery (1 case). Three patients died. HUS is the most common cause of organic acute renal failure in newborns. Diagnosis is essentially biological, treatment is mostly symptomatic.

Hypothyroïdie congénitale à Dakar: à propos de 28 cas

Child hypothyroidism has been little studied in Senegal. The aim of this study was to evaluate the epidemiological, diagnostic and evolutionary aspects of congenital hypothyroidism. We conducted a descriptive-analytical retrospective study of all children treated for congenital hypothyroidism at the Albert-Royer National Childrens Hospital Center over the period from 2001 to 2014 (14 years). We collected and analyzed socio-demographic, clinical and evolutionary data from patient medical records. A total of 28 patients were included in the study, an average of 2 cases per year. The average age of discovery of hypothyroidism was 54.25 ± 43 months with a female predominance (Sex-ratio 0.47). Only 2 cases of hypothyroidism were diagnosed in the neonatal period. Consanguinity was present in 68% of patients. Clinical signs were dominated by the delay in psychomotor acquisitions (96%), hypothermia (46%), cranio-facial dysmorphia (43%) and goiter (39%). Growth retardation was constant beyond 6 months. The etiologies were dominated by hormonosynthesis disorders (84.21%). During the study period, mean SD of patients had decreased from -3.5 SD to -2.25 SD for a median treatment duration of 28 months. Mental retardation was present in 73% of cases. Growth retardation and mental retardation were more severe as the diagnosis was late. Our results confirm the inadequacy of early management of patients. It is urgent to implement a routine neonatal screening system in order to improve the mental prognosis of this condition.

SFCP P-102 - Malnutrition et hospitalisation chez les moins de cinq ans

Pour determiner la prevalence hospitaliere de la malnutrition et son impact sur la mortalite des enfants de moins de cinq ans, nous avons etudie l’evolution des parametres anthropometriques. Le poids, la taille et le perimetre brachial etaient evalues chez tous nos patients a l’admission et a la sortie et un hemogramme etait realise. Nous avons trouve des prevalences de 38,2% pour l’emaciation, 31,3% pour le retard de croissance, selon les normes OMS et 73,8% pour l’anemie. A la sortie, la prevalence de la malnutrition aigue a baisse, passant de 38,2% a 29,5%. Une degradation nutritionnelle etait apparue chez les enfants n’ayant pas presente pas une malnutrition a l’admission. La duree moyenne d’hospitalisation (16±3jours) etait significativement plus longue (p=0,0001) en cas de malnutrition initiale. Le taux cumule de deces etait de 11,3%, avec un risque 4 fois plus eleve en cas de malnutrition aigue. L’absence d’allaitement maternel exclusif dans les 6 premiers mois de vie et la mauvaise conduite de l’alimentation etaient les principaux facteurs de risque. En milieu hospitalier pediatrique, la prevalence de la malnutrition reste elevee, avec un impact reel sur la survie des enfants, d’ou la necessite d’ameliorer la prise en charge nutritionnelle.