Olusegun Joseph Adebami

Comparison between CANSCORE and other anthropometric indicators in fetal malnutrition

ObjectiveEarly detection of malnutrition in newborn babies is of major importance in order to prevent associated serious sequelae. Main objective of the study was to compare various anthropometric methods with Clinical assessment of nutritional status score (CANSCORE) in assessing fetal malnutrition.MethodsSubjects were consecutive, live, singleton, full term neonates delivered in the hospital. The mean weight, chest circumference, mid arm circumference, and Ponderal index of babies and CANSCORE described by Metcoff4 were assessed and compared.ResultsA total of 442 term singleton live born neonates were assessed. They consisted of 228 [51.6%] males and 214 [48.4%] females. Eighty-three [18.8%] of the 442 babies had fetal FM. The mean weight, mid arm circumference, and Ponderal index of babies with FM were significantly lower than those of babies without FM (p < 0.0001). Though the mean head circumference and the length of the babies with FM were also lower, the differences were not statistically significant (p = 0.50 and 0.79 respectively). However, using intrauterine growth standard alone, 41 (49.4%) of the 83 babies with fetal malnutrition would have been missed while Ponderal Index would also have missed 51 (61.4%) of the babies with FM.ConclusionCANSCORE is likely to be very useful in the routine screening of babies for anticipatory care.

Maternal factors in the etiology of fetal malnutrition in Nigeria.

Background: The main objective of the study was to determine the role of maternal factors in the etiology of fetal malnutrition (FM) in Nigeria. Neonatal and Maternity Units of the Wesley Guild Hospital Ilesa, Nigeria, a unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile‐Ife was the setting for the study.

Factors associated with the incidence of acute bilirubin encephalopathy in Nigerian population

Acute bilirubin encephalopathy (ABE) is still a major and common health problem in developing countries in spite of the availability and efficacy of phototherapy and exchange blood transfusion. In developing countries, the prevalence of kernicterus has not shown any reduction because many babies with jaundice present very late in well established kernicterus. The study was done to determine the factors responsible for the late presentation of neonatal jaundice and development of ABE among the patients presenting with this condition in our health facility. All newborns presenting with ABE at the special care baby unit of the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria were prospectively studied. The diagnosis of ABE was made clinically if there were neurologic abnormalities associated with hyperbilirubinemia. Twenty-eight (3.2%) of 882 babies admitted over 3 yr had ABE. There were 21 males, 7 females, and the male: female ratio 3:1. Twenty-two (78.6%) of the mothers saw at least one health worker more than 24 hr before presentation. Three (10.4%) other mothers who noticed the jaundice did not initiate any treatment while the remaining three (10.4%) mothers did not notice the jaundice in their babies until they presented at the health facility with the complaint of failure to suck. Prescribed medications before presentation were oral antibiotics, hematinics and gentamicin injections, a solution of Naphthalene balls in water and an extract of local herbs made from Pawpaw leaves. Causes of jaundice were septicemia, G6PD deficiency, ABO incompatibility, low birth weight and rhesus isoimmunization in decreasing order of frequency. Maternal factors include low socioeconomic status, teenage and low parity statuses of the mothers. Inappropriate treatment of neonatal jaundice by health workers was also one of the underlying reasons. Therefore, there is need to raise the level of awareness in the community of the occurrence and dangers of neonatal jaundice and its appropriate treatment. Health workers themselves need education and training in the early recognition and treatment of neonatal jaundice.

Clinical and laboratory predictors of outcome in cerebral malaria in suburban Nigeria.

INTRODUCTION Cerebral malaria (CM) is an important cause of morbidity and mortality among children living in the tropics. The present study was conducted to update the knowledge on cerebral malaria in children. METHODOLOGY This was a prospective study conducted between June 2009 and February 2010. Consecutive children who met the clinical and parasitological diagnostic criteria for CM were admitted and studied. Demographic, essential history, clinical examination findings and laboratory results were recorded and analyzed. Outcome in survivors (presence or absence of neurological deficits) were determined at discharge. RESULTS Out of 1,202 children admitted during the study period, 66 (5.5%) had CM: 40 boys and 26 girls. Ages ranged from 2 to 128 months (mean: 41.6 ± 27.1 months). Fever (100%), coma (100%) and convulsion (89%) were the commonest presenting symptoms, while unsteady gait, speech, auditory and visual impairment were the commonest neurological deficits at discharge. Fifty-seven (86.4%) patients survived while nine (13.6%) died. Of the 57 survivors, 35 (61.4%) recovered completely, while 22 (38.6%) had neurological deficits at discharge. Identified clinical and laboratory predictors of mortality in CM included: age less than 3 years (p = 0.031), abnormal breathing pattern (p = 0.023), absent corneal reflex (p = 0.005), absent pupillary reflex (p = 0.047), retinal haemorrhage (p = 0.029), hypoglycaemia (p = 0.002) and leucocytosis (p = 0.040). CONCLUSION CM is associated with high mortality and serious sequelae. Affected children should be given proactive management and monitored closely to reduce the frequency of adverse outcomes.

Neurological disorders among children in Osogbo, southwestern Nigeria

Neurological disorders in children cause disability, handicapping and reduction in the potential of the affected child and are therefore sources of major concern to parents, health workers and governments worldwide. To determine the pattern of neurologic abnormalities at a follow up clinic in our health facility, a descriptive study of the patients who attended the neurology clinic of Ladoke Akintola University of Technology Teaching Hospital. Osogbo for 4 yr that is, between January 2006 and December 2009 was undertaken. The data obtained at first clinic attendance included age, sex, family history of neurological disorders and clinical presentations. Detailed physical and neurological examinations and the anthropometric measurements of the patients were also performed. Two hundred and forty nine patients were studied. One hundred and forty two (57.0%) males and 107 (43.0%) females with male:female ratio 1.33:1. The ages of the patients at first contact ranged between 2 to 168 mo (2 mo to 14 yr) with the mean of 56.83 ± 49.56 mo. Leading clinical presentations were seizures in 168 (67.5%), developmental delay in 86 (34.5%), movement disorders, ataxia and gait abnormalities in 44 (17.7%), and microcephaly in 36 (14.4%). In descending order, the maain diagnoses were cerebral palsy, kernicterus and Down syndrome, post-meningitis complications, craniosynostosis, post-cerebral malaria complications and acute flaccid paralysis Patients were managed with chemotherapy, physical therapy, social and surgical care. To reduce the burden of neurologic abnormalities, a multi-pronged approach must be pursued at controlling the prevailing factors of cerebral palsy, kernicterus and meningitis. Improvement and sustained immunization programs – especially against poliomyelitis and measles – should also be ensured.

Fatal scorpion sting in a child

Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2-year-old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.

G411(P) Relationship between maternal and cord blood zinc levels at term

Aims Zinc deficiency is one of the most common micronutrient deficiencies in developing countries. Maternal zinc deficiency is associated with foetal growth retardation and other adverse foetal outcomes. The study aimed to determine serum zinc concentrations of study subjects, provide much needed information on the prevalence of both maternal and cord blood zinc deficiency, as well as the relationship between maternal and cord blood zinc levels. Methods This cross-sectional study was conducted with 386 consecutive pregnant women recruited at term (37–42 weeks gestation). Maternal and cord blood samples were taken at delivery. Estimation of serum zinc concentration was by atomic absorption spectrophotometry. Results The mean serum zinc concentration in the maternal blood and cord blood were 9.0 (6.1) mmol/L and 13.1 (7.8) mmol/L respectively. One hundred and ninety-nine (51.6%) mothers had normal zinc levels while 187 (48.4%) mothers had hypozincaemia (serum zinc concentration below 7.6 µmol/L15. Also, 233 (60.4%) of the 386 babies had normal zinc levels while 153 (39.6%) had hypozincaemia (serum zinc concentration below 9.9 mmol/L)15. The mean cord serum zinc concentration was significantly higher than maternal serum zinc concentration (t = 33.12, p = 0.000). There was a significant association between the prevalence of low maternal and cord serum zinc levels; and normal maternal and cord serum zinc levels (X2 = 71.105, df = 1, p = 0.000) (Table 1). There was a positive correlation between paired maternal and cord blood zinc concentrations (r = 0.403, p = 0.000) (Figure 1). No significant correlation existed between gestational age and serum zinc levels in the maternal or cord blood.Abstract G411(P) Figure 1 Scatter plot of maternal and cord serum zinc with line of best fit (r = 0.403, p = 0.000)Abstract G411(P) Table 1 Association between maternal and cord serum zinc Conclusion There is a high prevalence of maternal and cord blood zinc deficiency in the study location which however did not reflect in the same magnitude in the newborn. Therefore, the role of zinc supplementation in pregnant women in developing countries still appears controversial. Reference Hotz C, Peerson JM, Brown KH. Suggested lower cutoffs of serum zinc cconcentrations for assessing zinc status: reanalysis of the second National Health and Nutrition Examination Survey data (1976 - 1980). Am J Clin Nutr. 2003; 78:756–764

Pattern of neonatal seizures in Osogbo, south-western Nigeria

Objectives. A study to determine the pattern and outcome of neonatal seizures. Design. A prospective descriptive study. Setting. Special Care Baby Unit, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Subjects. All newborn infants with observed seizures admitted between January 2006 and December 2008. Results. Of 866 neonates admitted, 59 (6.8%) had seizures; of these 43 (72.9%) had been born outside our health facility (outborn). Babies with seizures had a higher birth weight than babies without seizures (p=0.008), and the incidence of seizures had a linear relationship increasing with the weights of the babies and inverse to their ages. Of the 59 babies with seizures, 37 (62.7%) were considered to have had birth asphyxia. Meningitis, hypoglycaemia, and hypocalcaemia occurred in 7 (11.9%), 6 (10.2%) and 2 (3.4%) of cases, respectively, and 7 (11.9%) had undiagnosed causes. Forty-two (71.2%) of the 59 babies had both subtle and generalised seizures. Twenty-seven babies with seizures died (45.8%) compared with 131 of 807 babies without seizures (16.2%, p=0.0001). Babies with seizures and asphyxia or who had been outborn had the highest risk of death (59.5% and 48.8%, respectively). Recommendations. The major causes of neonatal seizures and death are potentially preventable. Comprehensive and vigorous efforts are needed to achieve safe delivery, prevent birth asphyxia and improve care and transport of sick neonates at the primary care level. In view of the high prevalence of seizures among severely asphyxiated neonates and those with meningitis, anticonvulsant chemoprophylaxis is recommended in these groups.