Diagnostic Value of Procalcitonin in Neonatal Sepsis

Introduction: Neonatal sepsis is a major cause of mortality in developing countries. Accurate and quick diagnosis are difficult because clinical presentation are non-specific; bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Serum procalcitonin (PCT) has been proposed as an early marker of infections in neonates. Objectives: This study investigated the value of PCT in the diagnosis of Neonatal Sepsis.Methods: Neonates undergoing sepsis evaluation at the Special Baby Care Unit; Federal Medical Centre; Abeokuta; Nigeria between January and April 2013 were included. Blood samples were obtained for white cell count; blood cultures; serum CRP and PCT analysis. Neonates were categorised into Proven Sepsis; Suspected Sepsis and Clinical Sepsis groups on the basis of laboratory findings and risk factors. A control group with no clinical and biological data of infection was also included. Predictive values and area under the receiver operating characteristic curve (AUC) of PCT were evaluated.Result: Of the 85 neonates; 19 (22.4%) had positive blood culture. PCT level was significantly higher in neonates in all sepsis groups in comparison with those in the control group (P 0.05). At a cut-off of 0.5 ng/ml; the negative predictive value (NPV) of PCT was 80% and the positive predictive value (PPV) 39%. There were no significant statistical difference between the AUC values of PCT in Early onset and Late onset sepsis; as well between AUC in Preterm and term cases. A higher percentage of neonates who died (96%) had elevated PCT levels compared to those who survived (46%).Conclusion: These findings support the usefulness of the PCT in diagnosis of Neonatal sepsis

Childhood injuries in Ilesa, South-Western Nigeria: causes, pattern, and outcome.

BACKGROUND: In Sub-Saharan Africa, infections and undernutrition are the leading causes of childhood death; however injuries are now contributing significantly to childhood morbidity and mortality. OBJECTIVE: To determine the aetiology, morbidity and mortality associated with injuries in children in South-Western Nigeria. METHODS: This was an observational cross-sectional study of consecutive childhood injury attendances and admissions into the hospital's Children Emergency Room (CHER) over a one-year period. Socio-demographic data as well as the data on the cause, site, and possible risks of injury; parts of the body affected and eventual outcome of the patients were documented. RESULTS: Injury accounted for 382 (10.6%) of the 3,604 attendances, 142 (11.9%) of 1193 admissions and 11 (20.4%) of 54 deaths in CHER. Their ages ranged from six weeks to 15 years, with a mean (SD) of 6.7 (3.9) years, and a male:female ratio of 1.6:1. Road traffic accidents, 130 (34.0%), were the most common cause, followed by falls 119 (31.2%), cuts 44 (11.5%), bits 26 (6.8%), and burns 24 (6.3%). Injuries occurred mostly at home 154 (40.1%), on the road 142 (37.4%), and at school 59 (15.2%). Lack of supervision and/or poor anticipation of potential dangers were the leading risks associated with childhood injuries. CONCLUSION: Injuries contribute significantly to childhood deaths in South-Western Nigeria. A well-orchestrated public enlightenment programme to improve home, school, and road supervision of children as well as concerted efforts to make these places safer could help ameliorate the situation.

Prevalence of overweight and obesity among children in Ile-ife, south-western Nigeria.

BACKGROUND: Childhood obesity is a potential health problem in Nigeria because of our changing patterns of lifestyle. It is associated with significant health, medical and psychological consequences for children and adolescents. OBJECTIVE: To determine the nutritional status of Nigerian children aged six to eighteen years using anthropometry. METHODS: The study which was a school-based cross-sectional survey employed a multi-staged random sampling method. Four secondary and four primary schools (two private and two public) were selected to ensure adequate representation of the focus age group of six to 18 years and social classes. Ninety students were selected from each school. Overall, 360 subjects were selected from primary and secondary schools respectively giving a total of 720 school children. Each subject had a questionnaire complete followed by the measurement of height and weight. Nutritional status was determined using the International Obesity Task Force criteria. RESULTS: Two (0.3%) of the 720 students studied were obese both being females. Twenty (2.8%) subjects were overweight of which 17 (85.0%) were females and three (15.0%) males. Females had a higher prevalence of overweight when compared with males. There was a higher proportion of overweight students in the higher social classes when compared with the lower social classes (p=0.03). Five hundred and sixty (77.8%) were underweight with a BMI less than 18.50. CONCLUSION: Obesity and overweight are rather uncommom problems among children in Ile-Ife a semi urban south-western Nigeria town. However, overweight is more common in children from high social classes and among adolescents, the girls tend to have higher BMI than the boys. Underweight is prevalent among these children.

The incidence and outcome of bilirubin encephalopathy in Nigeria: a bi-centre study.

OBJECTIVE: To determine the current trends in the incidence and outcome of bilirubin encephalopathy among Nigerian babies. METHODS: A review of the hospital records of babies managed for bilirubin encephalopathy at the Wesley Guild Hospital (WGH), Ilesa and Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, both in southwest Nigeria between 2001 and 2005 was carried out. The age, sex, weight, body temperature on admission, place of delivery and outcome of hospitalization were studied. The fatal cases and the survivors were compared for risk factors for mortality. RESULTS: Fifty eight (3.4%) and 57 (2.3%) babies had bilirubin encephalopathy out of 1706 and 2492 total neonatal admissions at OOUTH and WGH respectively. Of these 115 babies, 3 (2.6%), 84 (73.0%) and 28 (24.3%) were aged <3 days, 3-6 days and 7 days or more. Sixty eight (59.1%) babies were delivered in orthodox health facilities. Aside clinically suspected cases of G6PD deficiency, ABO incompatibility and septicaemia were commonly associated with bilirubin encephalopathy, Forty four (38.3%), 36 (31.3%) and 35 (30.4%) had Unconjugated bilirubin of <340 micromol/L, 341-425 micromol/L and >425 micromol/L respectively Sixty eight (59.1%) were discharged, 42 (36.5%) died while 5 (4.7%) were discharged against medical advice. Prematurity, low birth weight, severe anaemia and inability to do Exchange Blood Transfusion were significant risk factors for mortality among babies with bilirubin encephalopathy. Cerebral palsy, seizure disorders and deafness were the leading neurological sequelae (86.4%, 40.9% and 36.4% respectively) among the 22 survivors who were followed up. CONCLUSION: Bilirubin encephalopathy remains a common clinical finding in Nigeria and the associated mortalities and neurological sequelae are significant.