Younoussa Keita

Prematurity: Epidemiology and Etiological Factors in a Maternity Ward in Dakar (Senegal)

Background: Prematurity is the leading cause of neonatal mortality and morbidity in the world. Several etiological factors contribute to its occurrence requiring identification for effective prevention. The objective of this work was to study the epidemiological and etiological factors of prematurity in the maternity ward of the Grand YOFF General Hospital (GYGH) in Dakar. Methods: This was a prospective study including all live and viable newborns conducted during January 1st to August 31st. They were divided into 2 groups: premature infants (22 WA-36 WA+6 days) and term infants (over 37 WA). Statistical comparisons were based on percentages for the chi-square test or Fishers exact small sample test. Results: During the study, 501 newborns were collected including 360 term neonates (71.9%) and 141 premature babies (28.1%). The sex ratio was 1.07. Of the premature babies, 48.2% were hypotrophic. There were 13 cases of premature death (9.22%). The occurrence of prematurity was significantly related to educational level, geographic origin and body mass index (BMI). The number of prenatal consultations (PNC) less than 3 was related to a risk of prematurity (p=0.001). Genitourinary infections (p=0.059), high blood pressure (p=0.047), pre-eclampsia (p=0.009), isolated anaemia (p=0.0001) and isolated bleeding (p=0.015) were found as significant etiological factors. Conclusion: In our study, several etiological factors associated with prematurity were identified. Combating these factors is an effective way to prevent prematurity in our low-income countries.

Le syndrome néphrotique idiopathique (SNI) de l’enfant à Dakar: à propos de 40 cas

Introduction L’objectif de ce travail était d’analyser les caractéristiques diagnostiques, thérapeutiques et évolutives de l’enfant atteint de néphrose dans un service de pédiatrie de Dakar. Méthodes L’étude était réalisée au service de pédiatrie de l’hôpital Aristide Le Dantec. Il s’agissait d’une étude rétrospective sur une période de 03 ans allant du 1er janvier 2012 au 31 décembre 2014. Ont été inclus tous les patients âgés de 02 ans à 12 ans présentant un tableau de Syndrome néphrotique idiopathique. Résultats Quarante cas de néphrose étaient colligés soit une prévalence de 23% parmi les néphropathies prises en charge dans le service. L’âge moyen était de 7,11± 3,14 ans. Le syndrome néphrotique était pur chez 72,5% (n=29) des patients. Les œdèmes des membres inférieurs étaient présents chez 100% des patients, l’oligurie dans 55% (n=22) et l’HTA dans 5% (n=2) des cas. La protéinurie moyenne était de 145,05 ± 85,54 mg/kg/24heures. La protidémie moyenne était de 46,42 ±7,88 g/L et l’albuminémie moyenne de 17,90 ± 7,15 g/L. Trente-neuf patients avaient reçu une corticothérapie à base de prednisone. La corticosensibilité était retenue chez 77% (n=30) des patients et la corticorésistance chez 13% (n=5) des cas. Le facteur de mauvaise réponse à la corticothérapie était un niveau de protéinurie initiale supérieure à 150 mg/kg/jour (p = 0,024). La biopsie rénale était réalisée chez 18% (n=7) des patients et retrouvait dans 57,2% (n=4) des cas une hyalinose segmentaire et focale. Le cyclophosphamide et l’azathioprine étaient associés aux corticoïdes dans 10% (n=4) des cas chacun. Le taux de rémission globale était de 89,8%. L’évolution vers l’insuffisance rénale chronique était notée chez trois (03) des patients. Conclusion La néphrose représentait près du quart des néphropathies prises en charge dans notre service. Le taux de rémission globale était élevé. Le seul facteur de mauvaise réponse à la corticothérapie était le niveau de protéinurie initiale élevée. En cas d’indication de la biopsie rénale chez nos patients, la HSF était la lésion la plus fréquemment retrouvée.

Holoprosencéphalie alobaire avec diabète insipide et hypothyroïdie chez un nourrisson de 10 mois

Holoprosencephaly (HPE) is a serious brain malformation due to a failure of medial forebrain cleavage. This is an abnormality which is more often associated with craniofacial malformations, psychomotor development delay, diabetes insipidus and variable endocrine disorders. It is due to different causes including chromosomal abnormalities (trisomy 13, 18)and polymalformative syndromes (CHARGE Syndrome). Diagnosis is based on brain imaging. A few rare cases have been described in the literature. We here report the case of alobar HPE in a 10-month old infant. Diagnosis was based on cerebral CT scan performed due to delayed psychomotor development and in the absence of visible malformations. Endocrine assessment allowed to detect central diabetes insipidus and central hypothyroidism, probably of hypothalamic origin.

Mutilation génitale féminine fatale chez une fille de 10 ans

Female genital mutilation (FGM) comprises all procedures involving partial or total removal of the external genitalia and/or any other procedures affecting the female genitalia, for cultural or religious reasons or for nontherapeutic purposes in general. FGM is responsible for a number of short-, medium-, and long-term complications that can engage the vital and functional prognosis, especially in African countries. We report on a case in a 10-year-old girl who underwent genital mutilation, a traditional type of total excision during the neonatal period. She was followed for urethral meatus stenosis, which then was complicated by obstructive chronic kidney failure and urinary sepsis, whose progression was fatal.

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.

Contribution of Dehydration and Malnutrition to the Mortality of Children 0-59 Month of Age in a Senegalese Pediatric Hospital

In-hospital mortality is an indicator of the quality of care. We analyzed the mortality of under five years children of Pediatric ward of Aristide Le Dantec teaching hospital to update our data, after an previous study conducted ten years earlier. Methods : This was a retrospective study involving children 0-59 months of age, hospitalized from January 1, 2012 to December 31, 2012. For each child, nutritional status was assessed according to 2006 World Health Organization growth standards; clinical and biological data were recorded. The outcome of the disease was specified. Bivariate and multivariable were used to identify risk factors for death. Results : 393 children were included. Overall mortality rate was 10% (39/393). Factors associated with death were severe wasting [OR = 8.27, 95% CI [3.79-18], male gender (OR = 2.98, 95% CI [1.25-7.1]), dehydration (OR = 5.4, 95% CI [2.54-13.43]) in the model using the weight-for- height z score, male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in using the height- for- age z score, male gender (OR = 2.7, 95% CI [1.19-6.24]), dehydration (OR = 7.5, 95% CI [3.39-16.76]), severe underweight (OR = 2.4, 95% CI [1.11-5.63]), in the model using the weight-for- age z score, and male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in that using MUAC. Dehydration and malnutrition are two independent factors of mortality. Our management protocols of dehydration and malnutrition have to be updated. Screening malnutrition has to be done systematically for each child by anthropometric measurements using WHO growth standards.