Neonatal macrosomia and associated morbidities in Sagamu, Nigeria

Background:The incidence of neonatal macrosomia is on the increase in many parts of the world. The impact of the condition on babyand child health has not received adequate research attention.Objective:To determine the prevalence,babyandmaternal characteristics, the pattern of neonatal morbidity and perinatal outcome of macrosomia.Methods:A retrospective study of all singleton deliveries with birth weight ≥4.0 kg was conducted at a tertiary facility in the south-western part of Nigeria between January 2013 and December 2014.Results:Eighty-eightnewbornbabies were macrosomic out of 1854 deliveries, resulting in a prevalence rate of 4.7%. The male-to-femaleratio was 2:1, while the mean (±SD)birth weight was 4.2 ± 0.3kg. There was no significant difference in the mean birth weights of the male and female babies(t=1.24, p=0.218). The meanmaternal age was 31.7 ± 5.1 years. Multiparous mothers had the highest proportion of macrosomic babies, whilemajority of mothers (77.3%) were either overweight or obese. One-minute Apgar score <7 was observed among28 (31.8%) babies.Twenty-three (26.1%) babieswere hospitalized for further management. Birth asphyxia, hypoglycaemia and hyperbilirubinaemiawere the leading morbidities. The perinatal mortality rate for macrosomic babies was 102.2 per 1000total births.Conclusion:The incidence of neonatal macrosomia is relatively low in our study population but falls within the range of prevalence rates reported from other parts of the country.Birth asphyxia, hypoglycaemia and hyperbilirubinemia are common morbidities among affected babies

Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

Background:Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings. Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies. Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016. Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges. Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges

The use of locally fabricated compact fluorescent lamps (CFL) phototherapy devices in the management of significant neonatal hyperbilirubinaemia

Abstract: One of the challenges of managing significant neonatal hyperbilirubinaemia in resource-poor settings is limited access to effective phototherapy devices hence the need to try appropriate technologies. The objective was to assess the effectiveness of Compact Fluorescent Lamps phototherapy devices in the management of significant neonatal hyperbilirubinaemia in a resource-poor setting. A cohort of babies with significant hyperbilirubinaemia managed with locally fabricated Compact Fluorescent Lamps (CFL) phototherapy devices (2014-2016) were compared with historical controls managed with conventional imported phototherapy devices (2007-2010) for the severity of hyperbilirubinaemia and requirements for Exchange Blood Transfusion. A total of 96 babies in the subject group and 202 babies in the control group were studied. The proportion of babies with peak TSB >30mg/dl was significantly higher among the controls compared to the subjects (p < 0.001). The interval between the commencement of phototherapy and the peak TSB was greater than 1 day among 30.2% (29/96) subjects compared to 74.3% (150/202) babies in the control group (p < 0.001). The mean duration of phototherapy was significantly shorter for the subjects compared to the controls. EBT was performed for 38.5% of the subjects and 51.5% of the controls. Single sessions of EBT were required for 78.4% of the subjects compared to 45.2% of the controls (p = 0.001). In conclusion, the locally fabricated Compact Fluorescent Lamps phototherapy devices reduced EBT rate among babies with significant hyperbilirubinaemia