Postnatal foot length in the estimation of gestational age in relation to intrauterine growth pattern among Nigerian neonates

Objectives: To determine the relationship between postnatal foot lengths and estimated gestational age (EGA) in relation to intrauterine growth patterns determined at birth among Nigerian neonates. Design: Hospital-based, cross-sectional. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Participants: 260 neonates with EGA 30- 42 weeks within 48 hours of life. Interventions: Postnatal foot lengths (FL) were measured with Vernier digital calliper in millimetres. The intra-uterine growth pattern was determined using the Lubchenco chart. Pearson correlation and regression analysis tests were performed. Main outcome measures: Postnatal foot length in relation to Intra-Uterine Growth Pattern. Results: The mean postnatal FL had a strong positive correlation with the EGA from 30 through 42 weeks (r = 0.855, p < 0.001). The overall mean foot length for preterm neonates was 65.44 (6.92) mm, while that of term neonates was 77.92 (4.24) mm. The linear regression equation was generated as: EGA = 9.43 + (0.37 × FL), p < 0.001. The EGA as measured by FL had the highest positive correlation with Small for Gestational Age (SGA) intra-uterine-growth pattern, followed by Appropriate for Gestational Age (AGA) and least by Large for Gestational Age (LGA) respectively (r = 0.936> 0.861 > 0.666). Conclusion: The postnatal foot length correlated well with estimated gestational age, and the correlation was best among SGA infants

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

Effect of Socio-demographic Characteristics on Obstetric Care-seeking Behaviours and Perinatal Outcome in Sagamu, Nigeria.

Background: The persistence of severe intra-partum events as causes of perinatal mortality may be due to the poor care pregnant women receive in labour. The quality and scope of care received in labour varies with the types of health facilities patronized. Objective: To describe the obstetric care-seeking behaviours of pregnant women in Sagamu, Nigeria and relate this to the perinatal outcome. Methods: A cross-sectional survey of parturient at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria was conducted between August 2013 and November 2014. Data were obtained on the demographic and obstetric profile, details of facilities visited during labour and perinatal outcome for analysis. Results: Out of 145 women, 93 (64.1%) received antenatal care at OOUTH. Of the 84 women who were first admitted in labour, 32 (38.1%) presented with emergencies. There were 140 live births and 10 still births; 34/140 (24.3%) of the live births were hospitalized mostly with asphyxia (13/34; 38.2%). One of the 34 hospitalized babies died from asphyxia thus the overall perinatal mortality rate was 73.3/1000 births. Women who presented with emergencies during labour and traversed other health facilities while in labour characteristically had low maternal education, low socioeconomic status and received antenatal care outside OOUTH. Poor perinatal outcome was significantly associated with unbooked status, presentation with emergencies during labour and traversing other health facilities in labour. Conclusion: Quality antenatal care and timely presentation during labour may influence perinatal outcome positively. Research should be focused on strengthening the existing health care structure.

Neonatal Septicaemia in a Rural Nigerian Hospital: Aetiology, Presentation and Antibiotic Sensitivity Pattern.

Background: Neonatal Septicaemia (NNS) remains a major cause of morbidity and mortality in neonates despite advances in antimicrobial therapy, life support measures and the early detection of risk factors. This study aimed at determining the risk factors, aetiologic agents and antibiotic sensitivity pattern of NNS in Wesley Guild Hospital, Ilesa. Methods: This was a prospective study involving 360 neonates admitted into Wesley Guild hospital, Ilesa over a period of seven months. Socio-demographic data and clinical characteristics of the neonates were collected using a standard proforma. Blood culture was done on admission and bacterial isolates were identified using standard procedures. Antibiotic susceptibility testing was done using disc diffusion method. Results: The prevalence of neonatal septicaemia (NNS) was 16.0% in this study. Multivariate regression model of significant risk factors revealed prolonged labour (AOR 2.2(1.036 - 4.912) p=0.041) as the only independent risk factor for NNS. Staphylococcus aureus was the predominant isolate (70%). The case fatality rate from the study was 25%. Ciprofloxacin (86.7%), Cefuroxime (82.7%) and Ceftriaxone (81.3%) were the antibiotics with the highest sensitivity, while the infective organisms were most resistant to Cloxacillin (80%) and Ampicillin (77.3%). Conclusion: Neonatal septicaemia remains a significant cause of neonatal mortality. S. aureus was the predominant bacterial isolate in this study. Cephalosporins should be considered as first-line antibiotics in its management. Prevention of preterm deliveries and encouraging good antenatal care and supervised deliveries will help in reducing the high incidence.

Pattern of childhood epilepsies in Sagumu, Nigeria.

OBJECTIVE: To determine the prevalence, aetiology and clinical pattern of childhood epilepsies in a Nigerian tertiary hospital. METHODS: A review of hospital records of children managed for epilepsies at the Pediatric Neurology Clinic. Data studied included the age at presentation, sex, socio-economic class, probable aetiology, clinical type of seizure, Electroencephalopgraphic (EEG) pattern and presence of other neurologic disorders co-existing with seizures. RESULTS: Out of 183 children, 138 had epilepsies giving a prevalence of 75.4%. Sixty nine (54.7%) were aged 6 months to 3 years at the first visit and 115 (69.9%) belonged to lower socio-economic classes IV and V. Birth asphyxia 47 (37.3%) and brain infections in 28 (21.9%) were the leading aetiologies. Generalized tonic-clonic seizures, complex partial seizures and rolandic seizures occurred in 55 (76.9%), 8 (6.3%) and 2 (4.8%) children respectively. Inter-ictal EEG abnormalities were recorded among 72/77 children. Seizures co-existed with other neurologic deficits in 86 (68.3%) of all epileptic cases. 95 (75.4%) children had defaulted from the clinic as at the time of the study. 21 (19.6%) had poor response to drug treatment. Presence of other neurological disorders (p = 0.029) and multiple aetiologies (p = 0.0000) were associated with poor response to drug treatment. CONCLUSION: Most cases of childhood epilepsy in Sagamu, Nigeria are due to preventable perinatal and neonatal conditions. Therefore, improved obstetric and neonatal care may reduce the prevalence of this condition.

Evaluating and managing neonatal acute renal failure in a resource-poor setting.

Acute renal failure (ARF) is encountered in neonatal care where it may be associated with significant morbidities. Pre-renal failure, which is due to impaired renal tissue perfusion, is the commonest type of ARF. It is amenable to treatment with excellent prognosis following prompt diagnosis and timely institution of appropriate intervention. Unfortunately, ARF in the newborn is usually asymptomatic and it is only suspected when a newborn infant has not been observed to pass urine over several hours or when serum Creatinine is observed to be elevated or rising. In resource-poor settings, it is often difficult to conduct detailed evaluation of suspected cases of newborn ARF due to lack of appropriate equipments and infrastructure. Similarly, therapeutic facilities are sparse and there is heavy reliance on conservative management of cases. Such difficulties encountered in the evaluation and management of newborns with ARF in most parts of the developing world, like Nigeria, where diagnostic and therapeutic facilities are limited are highlighted.