Olusoga B. Ogunfowora

Neonatal malaria in Nigeria -a 2 year review

BackgroundIn view of the fact that a significant proportion of neonates with malaria may be missed on our wards on the assumption that the disease condition is rare, this study aims at documenting the prevalence of malaria in neonates admitted into our neonatal ward. Specifically, we hope to describe its clinical features and outcome of this illness. Knowledge of these may ensure early diagnosis and institution of prompt management.MethodsMethods Hospital records of all patients (two hundred and thirty) admitted into the Neonatal ward of Olabisi Onabanjo University Teaching Hospital, Sagamu between 1st January 1998 and 31st December 1999 were reviewed. All neonates (fifty-seven) who had a positive blood smear for the malaria parasite were included in the study. Socio-demographic data as well as clinical correlates of each of the patients were reviewed. The Epi-Info 6 statistical software was used for data entry, validation and analysis. A frequency distribution was generated for categorical variables. To test for an association between categorical variables, the chi-square test was used. The level of significance was put at values less than 5%.ResultsPrevalence of neonatal malaria in this study was 24.8% and 17.4% for congenital malaria.While the mean duration of illness was 3.60 days, it varied from 5.14 days in those that died and and 3.55 in those that survived respectively. The duration of illness significantly affected the outcome (p value = 0.03). Fever alone was the clinical presentation in 44 (77.4%) of the patients. Maturity of the baby, sex and age did not significantly affect infestation. However, history of malaria/febrile illness within the 2 weeks preceding the delivery was present in 61.2% of the mothers. Maternal age, concurrent infection and duration of illness all significantly affected the outcome of illness. Forty-two (73.7%) of the babies were discharged home in satisfactory condition.ConclusionIt was concluded that taking a blood smear to check for the presence of the malaria parasite should be included as part of routine workup for all neonates with fever or those whose mothers have history of fever two weeks prior to delivery. In addition, health education of pregnant mothers in the antenatal clinic should include early care-seeking for newborns.

Changing trends in newborn sepsis in Sagamu Nigeria: bacterial aetiology risk factors and antibiotic susceptibility.

Aim:  Sepsis is a major contributor to newborn deaths in the developing world. The objective is to determine the prevalence of newborn sepsis, the bacterial pathogens and antibiotic sensitivity pattern of the isolates.

Predictors of Acute Bilirubin Encephalopathy Among Nigerian Term Babies with Moderate-to-severe Hyperbilirubinaemia

OBJECTIVE To determine predictors of acute bilirubin encephalopathy (ABE) among term infants presenting with moderate-to-severe hyperbilirubinaemia. METHODS Babies with total serum bilirubin >15 mg/dl at the point of admission were studied in a Nigerian tertiary health facility using bivariate and multivariate analysis. RESULTS Out of 152 babies, 75 (49.3%) had ABE: 73 had ABE at presentation while two developed ABE after admission. Bivariate analysis showed that body weight <2.5 kg, outside delivery, low maternal education, low socio-economic status, severe anaemia, glucose-6-phosphate dehydrogenase deficiency and metabolic acidosis were significantly associated with ABE. Multivariate analysis also showed that only outside delivery, weight <2.5 kg, presence of severe anaemia and acidosis were the predictors of ABE in this cohort of term babies. CONCLUSION The identified predictors of ABE are modifiable and can be used to draw up screening tools for term babies at risk of ABE especially in the developing world.

Prevalence and risk factors for hypothermia on admission in Nigerian babies <72 h of age

Abstract Background: Hypothermia is a major contributor to early neonatal deaths especially in the developing world. Factors which predispose babies to hypothermia need to be identified for intervention purposes. Objectives: To determine the prevalence and risk factors for neonatal hypothermia at admission in the first 72 h of life. Methods: Babies hospitalized within the first 72 h of life in a Nigerian Neonatal Unit were surveyed. Data collected included age, sex, weight, place of delivery, history of breastfeeding, recent bath, oil cleansing of the skin and presence of asphyxia. Babies with skin (axillary) temperature <36.5°C were considered hypothermic. Results: Of the 111 babies, 75 (67.6%) were hypothermic. The prevalence of hypothermia was high among babies aged <6 h (80.6%), preterm infants (88.9%), low-birth-weight babies (89.1%), babies with birth asphyxia (76.3%), babies without recent oiling of the skin (90.6%) and babies who had not been breastfed (79.2%). Using logistic regression, significant risk factors for early neonatal hypothermia at admission included low-birth-weight (P=0.000) and lack of breastfeeding (P=0.028). Conclusion: Most of the identified risk factors are preventable. The warm chain should be strictly applied in-hospital and be taught to mothers and community health workers.

Predictors of Mortality in Neonatal Septicemia in an Underresourced Setting

OBJECTIVE To determine the predictors of mortality in neonatal septicemia. METHOD The records of babies with culture-proven septicemia managed in a Nigerian newborn unit between 2006 and 2008 were studied using bivariate and multivariate analysis. RESULTS Out of 174 babies with septicemia, 56 (32.2%) died. Outborn babies, babies with estimated gestational age (EGA) less than 32 weeks, weight less than 1.5 kg, temperature less than 38 degrees C, respiratory distress, abdominal distension, poor skin color, hypoglycemia, and infection with gram-negative pathogens were significantly associated with death by bivariate analysis. Multivariate analysis of these risk factors confirmed that EGA less than 32 weeks (odds ratio [OR], 5.5), respiratory distress (OR, 3.4), abdominal distension (OR, 2.7), poor skin color (OR, 3.3), and hypoglycemia (OR, 5.2) had significant independent contributions to the occurrence of death among babies with culture-proven septicemia. CONCLUSION Most of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to determine the clinical severity among septic babies.

Pattern and determinants of blood transfusion in a Nigerian neonatal unit

OBJECTIVE To determine the pattern and determinants of blood transfusion in a Nigerian neonatal unit. MATERIALS AND METHODS Newborn babies who required blood transfusions between January and December, 2008, were studied. The sex, age, and weight at the first transfusion, clinical conditions, indications for transfusion, and the outcome were analyzed with bivariate and multivariate methods. RESULTS A total of 402 neonates were hospitalized and 112 (27.9%) had blood transfusion; 61.9% had exchange transfusion, 66.1% had red cell transfusion, and 8% had plasma transfusion. There were 251 transfusions with a rate of 4.8 transfusions per week. Blood transfusions were done for severe jaundice (55.4%), severe anemia (40.2%), and bleeding disorders (4.4%). Weight < 2.5 kg, outside delivery, and jaundice were independent determinants of neonatal transfusion. CONCLUSION The blood transfusion rate in this facility was remarkably high. Improved standard of newborn care and infrastructural support are required to reduce the transfusion rate.

Pattern and determinants of newborn apnea in an under-resourced Nigerian setting

OBJECTIVE To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting. DESIGN Retrospective study. MATERIALS AND METHODS Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis. RESULTS Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight <2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% among apneic babies. CONCLUSION Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings.

Risk factors for mortality in neonatal seizure in a Nigerian newborn unit

Objective. To determine the risk factors for mortality in neonatal seizures. Methods and design. A prospective study of consecutive newborn babies with seizures admitted to a Nigerian hospital between January and December 2006. Multiple regression analysis was used to determine the risk factors for mortality among consecutive neonates admitted with seizures. Results. Seventy-eight babies were studied. Thirty-six of these (46.1%) had seizures within the first 24 hours of life. The mean age at onset of seizure was 85.4 ± 106.1 hours. The leading aetiologies included hypocalcaemia 65.4%), hypoxic-ischaemic encephalopathy (HIE) (60.3%) and hypoglycaemia (50.0%). Severe anaemia occurred in 56.4% of babies. Most (85.9%) had multiple aetiologies while no aetiology was identified in 5.1%. The mortality rate was 43.6%. Significant risk factors for mortality included duration of seizure longer than 24 hours (p = 0.019), hypoglycaemia (p = 0.001) and severe anaemia (p = 0.004). The co-existence of HIE with hypoglycaemia and hypocalcaemia was also more significantly associated with mortality (p = 0.03) than each of hypoglycaemia and hypocalcaemia co-existing with HIE separately. Conclusion. The prevention of fatal neonatal seizures should start with good intrapartum care, prompt detection and correction of hypoglycaemia and anaemia and early control of seizures.

Does infant feeding method influence the incidence and pattern of morbidities among human immunodeficiency virus-exposed uninfected nigerian infants?

Background: Human immunodeficiency virus (HIV)-exposed infants enrolled into the prevention of mother-to-child transmission of HIV program generally receive antiretroviral therapy (ARV), but the feeding methods differ based on several socioeconomic and cultural differences. Objective: The objective of the study was to examine the incidence and pattern of morbidities among HIV-exposed uninfected (HEU) Nigerian infants and determine any relationship with infant feeding methods. Methods: A review of the hospital records of all HEU infants attending the Virology Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between July 2013 and June 2015, was done. The recorded data included biodemographic profile, social parameters, feeding methods, anthropometry, and morbidities. The feeding method groups were statistically compared in relation to the various morbidities. Results: Out of 119 children, 81.5% were exclusively breastfed, whereas 18.5% had exclusive breast milk substitute feeding. About half had various morbidities which included upper airway infections (UAIs) (16.8%), malaria (15.9%), malnutrition (8.4%), diarrhea (8.4%), and pneumonia (2.5%). The frequencies of these conditions were similar among infant groups irrespective of feeding method. The infants with and without morbidities were comparable in terms of the frequency of exclusive breastfeeding (80.3% vs. 82.8%). Low family socioeconomic status (SES) (odds ratio [OR] = 7.7) and ARV use (OR = 0.4) among infants were predictors of morbidities among HEU infants. Conclusion: The incidence and pattern of morbidities among HEU infants showed no relation to the mode of feeding. Rather, family SES and the use of antiretroviral drugs were predictors of morbidities among HEU infants.

Infantile hypertrophic pyloric stenosis with unusual presentations in Sagamu, Nigeria: a case report and review of the literature.

A 24-day old female Nigerian neonate presented with protracted vomiting, fever and dehydration but without palpable abdominal tumour or visible gastric peristalsis. There was no derangement of serum electrolytes. The initial working diagnosis was Late-Onset Sepsis but abdominal ultrasonography showed features consistent with the diagnosis of IHPS. This case report highlights the atypical presentation of this surgical condition and the need to investigate cases of protracted vomiting in the newborn with at least, ultrasonography to minimize complications and reduce the risk of mortality in a resource-poor setting.