Comparison between CANSCORE and other anthropometric indicators in fetal malnutrition.

OBJECTIVE: Early 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. METHODS: Subjects 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 Metcoff were assessed and compared. RESULTS: A 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. CONCLUSION: CANSCORE is likely to be very useful in the routine screening of babies for anticipatory care.

Predictive factors for birth trauma in southwestern Nigeria

Birth trauma is a significant cause of neonatal morbidity and mortality. This prospective study determined the predictive factors for birth trauma as seen in a Nigerian university teaching hospital. This was a prospective descriptive evaluation of birth trauma at Wesley Guilds Hospital, Ilesa over three years. Semi-structured questionnaire was used to collect data on the age, gender, pattern of presentation, place and mode of delivery, level of birth attendants, and treatment offered. Outcome measures were factors predisposing to birth trauma. A total of 137 neonatal hospital admissions with birth related complaints were recorded between 10th December, 2002 and 9th December 2005, out of which 119(86.8%) patients had 121 birth injuries (Males: Females= 1.4: 1). The mean age was 6 ± 4.1 (range: 1-31) day. Non skeletal injuries included cephalohaematoma 30(24.8%), genital bruises/abrasion 4(3.3%), subconjuctiva haemorrhage 2(1.7%), subdural haemorrhage 1 (0.8%), nasal necrosis 1(0.8%), Erb`s`palsy 31(25.6%) and Klumpke`s palsy 2(1.7%). Skeletal injuries were mainly bone fractures 50(41.3%)with 2(1.7%)mortality. Ante natal care/delivery, level of birth attendants, mode of delivery, fetal distress, and emergency caesarian section were among the factors that determined birth trauma. The prevalence of birth trauma is high in southwestern Nigeria. The predictive factors are easily identifiable in the perinatal period; early recognition could reduce significantly birth trauma

Iatrogenic burns injury complication neonatal resuscitation

A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury; with surface area coverage of about 4; involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice

Neonatal morbidity and mortality in Nigeria.

A retrospective analysis of neonatal morbidity and mortality was conducted over a ten-year period (1981-1990) at a tertiary hospital in Ilesa, Nigeria, to determine the trends in neonatal morbidity and mortality in relation to places of delivery. 7,225 babies were admitted into the neonatal unit during the period wherein 3,232 (44.7%) were inborns and 3,993 (55.3%) outborns. Places of delivery of outborn babies were government hospitals/maternity centres (44.1%), home (28.5%), private hospitals/clinics (18.8%), and mission houses (8.7%). Major indications for admission among inborns were neonatal jaundice (45.6%), low birthweight (18.6%), birth asphyxia (14.2%), and neonatal infections (9.3%), while those for outborns were neonatal jaundice (39.5%), low birthweight (23.2%), neonatal infections (18.0%), neonatal tetanus (5.7%), birth asphyxia (4.8%). Overall mortality rate was 13.0%. It was higher in outborns than inborns (p < 0.001). Mortality was lowest in 1983 and peaked in 1987 and 1988. It was higher in outborns than inborns during the period (p < 0.001). Major causes of death were low birth weight (42.8%), neonatal jaundice (14.1%), neonatal tetanus (12.8%), infections (12.4%), and birth asphyxia (11.6%). In almost all cases, case fatality rates were higher among the outborns (p < 0.001). Similarly, mortality was higher in outborns than inborns in almost all the weight range. Among the outborns, mortality was highest in babies delivered at home and private hospitals. Improved access to neonatal medical and antenatal care will significantly reduce neonatal morbidity and mortality in Nigeria.

Acute chest syndrome in children with sickle cell disease.

Acute chest syndrome (ACS) is an acute pulmonic process in patients with sickle cell disease. We prospectively studied 50 patients with ACS admitted to the Pediatric Medical Ward during one year period (Jan. 1993 through Dec. 1993). Twenty eight of them were males and twenty two were females giving a male: female ratio of 1.2:1. The age ranged between one and 12 years. Twelve (24%) of the patients had chest pain on presentation. Twenty seven (54%) patients had significant temperature (> 38 degrees C). The x-ray findings showed that the right lung was involved in 30 patients, the left in 10 patients and both lungs in 10 patients. Three patients had pleural effusion that required chest tube insertion. Laboratory profiles showed that the erythrocyte sedimentation rate ranged between 15 and 90 mm/h, and their hemoglobin ranged between 4.2 gm and 12 gm/dl. Seven (14%) patients had significantly positive mycoplasma pneumoniae titer. None of the blood cultures was positive. All of our patient received antibiotic, usually either Cefuroxime or Ceftriaxone with Erythromycin in addition to other supportive measures such as blood transfusion, oxygen therapy and hydration therapy.

Improved survival rate in neonatal tetanus among babies of immunised mothers

Fifty-two neonates admitted for tetanus into our neonatal unit at Wesley Guild Hospital; Ilesa over a thirty-month period were analysed in relation to maternal immunisation with tetanus toxoid during pregnancy. Seventeen (32.7) of the babies were delivered to mothers who had tetanus toxoid immunisation during pregnancy. The male to female ratio; mean age and weight of babies in the two groups were similar. Six mothers took discharge of their babies against medical advice. Twenty (43.5) of the remaining 46 babies died. The fatality rates in the 16 infants of mothers who had tetanus toxoid and 30 infants of mothers who did not have tetanus toxoid during pregnancy were 12.5and 60respectively (P0.01). This report thus shows that neonatal tetanus can occur in babies of mothers immunised with tetanus toxoid during pregnancy but that maternal immunity probably improved the prognosis of neonatal tetanus in such infants