A review of the epidemiology, post-neurosurgical closure complications and outcomes of neonates with open spina bifida

Background. Spina bifida (SB) is a neural tube defect (NTD) that has an increased risk of fatal and disabling effects if not repaired early, i.e. within the first 24 to 48 hours of life. Its diagnosis holds an increased burden for the patient and the caregiver owing to secondary complications. The effects of the disease are detrimental even with early repair, because of the long-term disabling nature of the disease.Objective. This retrospective study aimed to assess the effects of demographics, immediate post-surgical complications and impact of time to surgical intervention on the outcome of neonates with open SB (OSB) admitted to the neonatal intensive care unit (NICU) at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal, South Africa (SA), between January 2011 and December 2015.Methods. A retrospective chart review was conducted at the NICU of IALCH. All neonates diagnosed with SB were identified. The study period was from 1 January 2011 to 31 December 2015. Data were collected from the IALCH electronic database. All neonates with SB admitted to the IALCH NICU were included; any patient who presented beyond the neonatal period (i.e. >28 days) was excluded from the study. Data collected included maternal demographics. Additionally, neonatal history was reviewed and post surgery complications evaluated. Outpatient management post discharge was reviewed.Results. One hundred and fifty neonates were included (58% male). The mean (standard deviation) maternal age was 26.7 (6.6) years. Only 10% had an antenatal diagnosis of OSB. Seventy-eight percent were born at term and 22% prematurely. The lumbar/sacral region was the most commonly affected. More males (14%) had thoraco/lumbar lesions than females (7.8%). Forty-eight percent presented before 3 days of life (early presentation). In the late-presentation group, there was an association with wound sepsis (p=0.003). Twenty-five percent were repaired between days 0 and 3 of life and 75% after 3 days. Postoperative complications in patients whose open SBs were repaired beyond 3 days of life were not statistically significant compared with those with early repair; all were p>0.05. There was a borderline association of prolonged hospitalisation with wound sepsis (p=0.07). Long-term outcomes showed that 68% had lower limb dysfunction, 18% urological complications, 14% limb deformity, and 11% hydrocephalus. A minority had psychomotor (7%) and developmental (15%) disorders. Ten percent required readmission secondary to shunt complications, and 7% died. Conclusion. SB remains a significant disease burden that affects outcome and survival of neonates in SA. Lack of good antenatal care, which includes early ultrasound and timely referral to centres, are barriers to good outcomes. Long-term follow-up is also necessary to prevent morbidity

A retrospective study on the prevalence, severity and outcomes of intraventricular haemorrhage in infants with a low birth weight in a quarternary hospital in a low- to middle-income country

Background. Intraventricular haemorrhage (IVH) is a serious complication in infants with a low birth weight (LBW). Objective. To study the prevalence, severity and outcomes of IVH in LBW infants admitted to a neonatal intensive care unit (NICU). Methods. This was a retrospective cohort study of LBW infants admitted to the NICU at a quarternary hospital between January and December 2012. Neonates with recorded cranial ultrasound scans were included and followed up to between 18 and 24 months of age for neurological outcomes. Results. An overall IVH prevalence of 44.3% (95% confidence interval 40 - 50) was observed in the study population (N=210). The prevalence of IVH in infants with a very low birth weight (VLBW) was 67.0%. Multivariable logistic regression showed risk factors for IVH to be VLBW, extreme prematurity, exposure to HIV, outborn delivery and receipt of a blood transfusion. Moderate to severe IVH was more common in VLBW and extremely premature infants. Severe IVH was associated with high mortality. At follow-up, 18.8% of the subjects showed signs of neurodevelopmental delay, while 6.3% were diagnosed with epilepsy. The overall all-cause mortality rate was 15.7% at discharge. Mothers' antenatal clinic attendance and caesarean delivery were protective factors. Conclusion. Improved perinatal care for women in preterm labour, especially in rural areas in South Africa, could lead to better outcomes in infants. A screening schedule could contribute to timeous detection of brain injury in at-risk babies to facilitate appropriate medical management and detection of lesions associated with adverse long-term neurodevelopmental outcomes

Feeding patterns of infants admitted with lower respiratory tract infections in an HIV-endemic area

Background. Lower respiratory tract infections (LRTIs) remain a major cause of mortality and morbidity in infants in South Africa (SA).Exclusive breastfeeding has been shown to decrease mortality and morbidity in infants with LRTIs, especially in the context of HIV/AIDS.Major effort has been put into educating HIV-positive mothers on the benefits of exclusive breastfeeding within effective prevention of mother-to-child transmission (PMTCT) programmes.Objectives. To determine the feeding practices among infants admitted with LRTIs in an HIV-endemic area.Methodology. The study was a retrospective chart review of all infants admitted with a diagnosis of LRTI between 1 January 2015 and 31December 2015 at King Edward VIII Hospital, Durban, SA. Data on feeding patterns, socioeconomic status, maternal HIV status and clinical outcomes of LRTI admissions were collected.Results. Of the 308 infants enrolled, 63% were male. Exclusive breastfeeding rates of those aged <6 months with LRTIs were higher thant hose found in previous studies; however, these feeding patterns were significantly associated with the HIV status of the mother(p=0.003).Mothers who were HIV-negative were twice as likely to breastfeed as those who were HIV-positive (odds ratio 2.25; 95% confidence interval 1.32- 3.88). There was no association between the type of feeding and the clinical outcomes for LRTIs.Conclusion. Maternal HIV status influenced the feeding patterns of infants admitted with LRTIs with lower exclusive breastfeeding rates in the HIV-exposed group. Despite extensive efforts to promote breastfeeding within effective PMTCT programmes, HIV-positive mothers are still not harnessing the benefits that exclusive breastfeeding provides

Cytokine Profile and Clinical Correlates in HIV-Exposed Infants with Severe (Hypoxic) Pneumonia

Introduction. Severe pneumonia in infants who are HIV-infected is a common problem in many parts of the developing world; especially sub-Saharan Africa. What has been missing from previous studies of severe pneumonia in HIV-infected infants; however; is a description of the host inflammatory response and cytokine/chemokine profile that accompanies this disease. Objective. To describe the cytokine profiles associated with severe hypoxic pneumonia in HIV-infected infants Methods. In a cohort of HIV-infected children diagnosed clinically with severe hypoxic pneumonia; paired serum and sputum cytokines were tested. A control group of HIV-infected children with bronchiectasis contributed matching controls.Results. A total of 100 infants (mean age 2.8 months) with a clinical diagnosis of severe hypoxic pneumonia were included in this study. IP-10 was markedly elevated in both sputum (mean 560.77pg/ml) and serum (mean 9091.14pg/ml); while IP-10 was elevated in serum (mean 39.55 pg/ml); with both these cytokines being significantly higher than in stable children with HIV-related bronchiectasis. Conclusion. This study of HIV-infected infants with severe hypoxic pneumonia suggests that IL-10 and IP-10 are associated with more severe lung disease. However; further investigation of this association is required