Rhythm abnormalities among hospitalised children in Lagos: a case series.

Arrhythmias refer to disturbances in heart rate or rhythm which leads to heart rates that are abnormally fast, slow or irregular. Rhythm abnormalities may be common among Nigerian children but there are only a few reports. The current write up is a clinical review of eight patients in various age groups including neonates, infants and older children. It is presented to highlight the different forms of arrhythmias that can occur in children, with varying underlying aetiology, thus, stressing the need for early recognition of arrhythmias in children, appropriate early intervention and challenges involved in their care.

Prevalence and determinants of peripheral arterial disease in children with nephrotic syndrome.

Peripheral arterial disease (PAD) is the least studied complication of nephrotic syndrome (NS). Risk factors which predispose children with NS to developing PAD include hyperlipidaemia, hypertension and prolonged use of steroids. The development of PAD significantly increases the morbidity and mortality associated with NS as such children are prone to sudden cardiac death. The ankle brachial index (ABI) is a tool that has been proven to have high specificity and sensitivity in detecting PAD even in asymptomatic individuals. We aimed to determine the prevalence of PAD in children with NS and to identify risk factors that can independently predict its development. A comparative cross-sectional study was conducted involving 200 subjects (100 with NS and 100 apparently healthy comparative subjects that were matched for age, sex and socioeconomic class). Systolic blood pressures were measured in all limbs using the pocket Doppler machine (Norton Doppler scan machine). ABI was calculated as a ratio of ankle to arm systolic blood pressure. PAD was defined as ABI less than 0.9. The prevalence of PAD was significantly higher in children with NS than matched comparison group (44.0% vs 6.0%, p < 0.001). Average values of waist and hip circumference were significantly higher in subjects with PAD than those without PAD (61.68± 9.1cm and 67.6± 11.2 cm vs 57.03 ± 8.3cm and 65.60± 12.5cm respectively, p< 0.005). Serum lipids (triglyceride, very low density lipoprotein, total cholesterol and low density lipoprotein) were also significantly higher in subjects with PAD than those without PAD [106.65mg/dl (67.8-136.7) vs 45.72mg/dl (37.7-61.3), 21.33mg/dl (13.6-27.3) vs 9.14mg/dl (7.5-12.3), 164.43mg/dl (136.1-259.6) vs 120.72mg/dl (111.1-142.1) and 93.29mg/dl (63.5-157.3) vs 61.84mg/dl (32.6-83.1), respectively p< 0.05]. Increasing duration since diagnosis of NS, having a steroid resistant NS and increasing cumulative steroid dose were independent predictors of PAD in children with NS; p< 0.05 respectively. With these findings, it is recommended that screening for PAD in children with NS should be done to prevent cardiovascular complications before they arise.

Serum Iron Status of Children with Cyanotic Congenital Heart Disease in Lagos, Nigeria.

OBJECTIVES: Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory secondary erythrocytosis. This study aimed to determine the serum iron status and prevalence of iron deficiency among children with cyanotic congenital heart disease attending the Paediatric Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. METHODS: This cross-sectional case-control study took place between May and October 2015 at the Lagos State University Teaching Hospital. A total of 75 children with cyanotic congenital heart disease and 75 apparently healthy age-, gender- and socioeconomically-matched controls were analysed to determine serum iron status and the prevalence of iron deficiency as defined by the World Health Organization criteria. RESULTS: The mean age of the children was 47.5 ± 2.9 months (range: 6-144 months old). Iron deficiency was significantly more frequent among CCHD patients compared to control subjects (9.3% versus 0%; P = 0.006). While latent iron deficiency was more prevalent among children in the control group compared to those with CCHD, this difference was not statistically significant (13.3% versus 9.3%; P = 0.303). No cases of iron deficiency anaemia were observed in the studied sample. CONCLUSION: Neither the children in the control group nor those with CCHD had iron deficiency anaemia. However, iron deficiency was significantly more prevalent among children with CCHD in Lagos. Periodic serum iron status screening is therefore recommended for this population.

Serum cystatin C levels in Healthy Nigerian neonates: Is there a need for normative values in Nigerian babies?

Cystatin C is an endogenous marker of renal function. Normal reference values have been documented in neonates outside Africa, but no study has been documented in African neonates. With reports that race may affect serum cystatin C values, this study was carried out to generate normal values in apparently healthy term neonates at birth and three days of life neonates in Nigeria. This was a hospital-based prospective study. A cohort of 120 apparently healthy term neonates were recruited at birth. Serum cystatin C was measured from the cord blood at birth and venous blood when they were three days old using enzyme-linked immunosorbent assay (ELISA) method. The mean serum cystatin C values for cord blood and 3rd day venous samples were 1.67 ± 0.52 mg/L and 1.62 ± 0.52 mg/L, respectively (P = 0.87). The cord blood and 3rd day serum cystatin C values for males were 1.67 ± 0.47 mg/L and 1.68 ± 0.51 mg/L, respectively (P = 0.77) and the values for females were 1.68 ± 0.56 mg/L and 1.58 ± 0.52 mg/L, respectively (P = 07.22). The serum cystatin C levels were similar among the different birth weight groups and gestational age (P >0.05). The cord blood and 3rd day serum cystatin C values were similar. Serum cystatin C values were independent of gender and birth weight of neonates. The values of serum cystatin C in Nigerian neonates were comparable to that reported for neonates in other regions of the world. It is recommended that ELISA technique may be reliably used to measure serum cystatin C levels in neonates.