Perinatal asphyxia in a rural Nigerian hospital: Incidence and determinants of early outcome.

BACKGROUND: Perinatal asphyxia is an important cause of morbidity and mortality in the neonatal period, accounting for 20-30% of neonatal mortality. A substantial proportion (estimated at 26%) of the 1 million annual intrapartum stillbirths result from asphyxia. Probably higher than the mortality is the plethora of morbidity associated with asphyxia, especially long term neuro-developmental problems including cerebral palsy.The real burden of perinatal asphyxia is difficult to establish because of paucity of information from the rural communities where the majority of neonatal morbidity and deaths occur. Extended Apgar scores and HIE grade have been identified as predictive tools in prognosticating asphyxia, however HIE staging require a certain level of medical expertise which is not widely available. AIM: To determine the incidence of asphyxia, the mortality rate and factors associated with mortality in Irrua Specialist Hospital. METHOD: It was a descriptive, retrospective study of neonates admitted into the special care baby unit (SCBU) between October 2013 and September 2014 with diagnosis of perinatal asphyxia. Data was obtained from babies' and mother's case notes. The outcome was classified as survived or died. RESULTS: Perinatal asphyxia accounted for 45 out of 347 (13%) of admissions within the review period. The mean gestational age and birth weight of the subjects were 39.2±2.2 weeks and 3020±520 grams respectively. The mortality rate was 31.1% and the factors significantly associated with mortality include lack of antenatal care and HIE stage III. CONCLUSION: The burden of perinatal asphyxia in Irrua Specialist Hospital is comparable to figures from similar settings in the developing world. Lack of antenatal care and HIE stage III are associated with mortality. Continuous efforts should be made to improve the uptake of antenatal care and high risk pregnancies should be delivered in centres with facilities for neonatal care.

Suspected progeria in Nigeria: a case report.

BACKGROUND: Progeria is a rare fatal genetic condition characterized by an appearance of accelerated aging in children. It has an incidence of 1 in 8 million and results from a mutation of the LMNA gene causing nuclear instability. Clinical diagnosis is based on recognition of common clinical features and definitive diagnosis is by identifying the mutation in the LMNA gene. Affected children usually have a median life span of 13 years. There is no known cure but research is ongoing. Currently about 80 children have had a definitive diagnosis worldwide with the exclusion of Nigeria. There was however a case report of 3 siblings in the University of Benin Teaching Hospital, Benin City, Nigeria in 1990. OBJECTIVE: To present a rare case of suspected progeria in Nigeria. CASE REPORT: We report the case of baby IV, a 4-year old girl who presented with clinical and radiologic features consistent with progeria. CONCLUSION: Clinical and radiologic evidence give a high suspicion of progeria in the index patient. Efforts are ongoing to ensure a definitive diagnosis is made; which will be the first diagnosed case of progeria in Nigeria.

Computed tomography study of complicated bacterial meningitis.

OBJECTIVE: To monitor the structural intracranial complications of bacterial meningitis using computed tomography (CT) scan. DESIGN: Retrospective study of medical and radiological records of patients who underwent CT scan over a 4 year period. SETTING: A University Teaching Hospital in a developing country. SUBJECTS: Thirty-three patients with clinically and laboratory-proven cases of bacterial meningitis who had clinical features of central nervous system complication of the disease. OUTCOME MEASURES: Only patients with available complete records were studied with material obtained from the medical records and radiology departments of the hospital. RESULTS: Persistent headache (30.3%), persistent fever (18.18%), seizures (15.5%) and torticollis (12.12%) were the most common presenting features that necessitated the request for CT scan. Communicating hydrocephalus (36.36%), cerebral abscess (12.12%), multiple areas of cerebral infarction (12.12%) and subdural empyema (9.09%) were the most common CT scan findings. The complications were more common in children aged less than 15 years. CONCLUSIONS: Computed Tomography is an accurate and useful means of diagnosing intracranial complications of bacterial meningitis. Early and effective diagnosis of treatable lesions such as hydrocephalus, cerebral abscess and subdural empyema will help improve prognosis of the patients. There appears to be no alternative to prevention, adequate and early treatment of this condition to reduce its long-term neurological sequelae.