Common Causes of Neonatal Death in Calabar, South-South Nigeria: An Autopsy Study

Background: Neonatal deaths are deaths of live born babies occurring before 28 completed days. The vast majority occur in low-income countries like Nigeria with a high neonatal mortality rate. There is paucity of autopsy studies due to refusal of family to give consent for such procedures. Aim: To identify the commonest causes of neonatal death in 53 neonatal autopsies in Calabar, Nigeria. Materials and Methods: Detailed postmortem was carried out using lettules techniques and bits taken for histological analysis to ascertain the cause of death. Other relevant contributory factors such as the gestational age, mode of delivery, place of birth, antemortem cause of deaths and maternal obstetric history were obtained from the medical records and autopsy request forms. Results: In the one-year retrospective study of 53 neonatal autopsies, male: female ratio was 1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days. The commonest cause of neonatal death was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6 cases (11.3%), birth trauma seen in 6 cases (11.3%), congenital heart disease seen in 5 cases (9.4%), and prematurity seen in 5 cases (9.4%). Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the definitive cause of death. Severe birth Asphyxia was identified as the commonest cause of death in the neonatal period followed by birth trauma, kernicterus and congenital heart diseases.

Demographics and Overall Survival Pattern of Chronic Myeloid Leukemia in a Tertiary Hospital in South-South Nigeria: The Calabar Experience

Background: Chronic myeloid leukemia (CML) is a bi- or triphasic disease comprising of the chronic phase (present at diagnosis in approximately 85% of patients) which can easily be controlled with conventional chemotherapy, followed by unstable accelerated phase and terminating in a blastic phase. The treatment of CML has evolved over the years The availability of the tyrosine kinase inhibitors has distinctly changed the disease course for patients with Ph+ and/or BCR-ABL1+ (CML). This study aims to determine the demographics and overall survival patterns of CML patients in the University of Calabar Teaching Hospital (UCTH)l. Methods: The study is a retrospective study of twenty-two (22) CML patients seen and managed at the UCTH from June 2014 to August 2021. Male/female distribution was 9/13, with a median age of 42 years. Overall survival (OS) and progression free survival (PFS) were determined using the Kaplan-Meier techniques. The data were analyzed using Microsoft Excel 2016 and IBM SPSS version 21. Results: Total of 22 CML patients were seen over the 8-year-period of review. The mean age was 42.63, median age 42, and modal age was 37 years respectively. There were 9 males and 13 females. 20 of the patients were in the chronic phase while 2 were in the terminating blastic phase. The presence of mutation was seen in two patients while the remaining 20 showed no mutation. Of the patients, 6 were dead and 16 are alive at the time of review. The overall survival period ranges from 12 to 84 months. The survival distributions for mutation and state of the disease (chronic or blastic) were not statistically significantly different, X2= 3.204, p = 0.073. Conclusion: There is inconsistency in the demographic and overall survival pattern of chronic myeloid leukaemia in our environment. Further study is needed to identify the factors which can help to improve the overall survival pattern in our environment

Critical Congenital Heart Disease Sadly Diagnosed at Autopsy in Calabar, South-South Nigeria

Congenital heart disease (CHD) is the most common type of birth defect causing more deaths in the first year of life than any other birth defect. Medical practice in a third-world country is faced with numerous challenges, created by poor health facilities and the unavailability of basic imaging studies at the community level where the majority of the poor resides. We present a case series of 4 neonates with a ratio of 1: 3 admitted into the neonatology unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Two of the patients were delivered at home by a traditional birth attendant via spontaneous vertex delivery and the rest two were booked cases in a private and obstetric unit of the University of Calabar Teaching Hospital. Their age ranged were 18 hours to 27 days of life and their common presentation were poor sucking, difficulty in breathing, central cyanosis and failure to thrive. A fetal echocardiogram was carried out for one of the cases and there was strong clinical suspicion of congenital heart disease but the precise type is unknown. The other three could not afford the necessary investigations required. They were all oxygen-dependent till death. Pathologic-anatomic findings showed a rare Critical congenital heart defect of the univentricular heart chamber of various types for the three cases and a case of TGA. The Immediate cause of death for all four cases was congestive cardiac failure.