Effect of Antenatal Corticosteroids in Late Preterm Delivery on Neonatal Respiratory Morbidity: A Randomized Controlled Trial.

Background: The use of antenatal corticosteroids beyond 34 weeks of gestation to prevent certain neonatal complications remains a debate. This study sought to determine the effect of the use of antenatal corticosteroids in late preterm delivery on neonatal morbidity. Methodology: It was a randomized double-blind placebo and active-controlled multi-arm trial. There were two study groups and one control group. It was conducted at the Department of Obstetrics and Gynaecology and the Department of Paediatrics of Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Pregnant women at 34 weeks to 36 weeks 6 days of gestation scheduled for elective delivery or who had emergency delivery were recruited for the study. The first study group had 2 doses of 12mg intramuscular dexamethasone and the second study group had 2 doses of 12mg betamethasone. The control group had 2 doses of a placebo. The primary outcome was the incidence of respiratory distress syndrome evidenced by tachypnoea with grunting, recession, or nasal flaring with diffuse reticulogranular infiltrate on X-ray or respiratory distress requiring the need for respiratory support by 72 hours of age. Secondary outcome measures included the need for neonatal resuscitation at birth, admission into the Special Care Baby Unit/Neonatal Intensive Care Unit, transient tachypnoea of the newborn, and apnoea. Results: A total of 138 mothers and 146 preterm neonates were included. A pairwise analysis was done to test for differences between the groups. There was no difference in the incidence of respiratory distress syndrome between the groups. However, the need for neonatal resuscitation was significantly higher (RR: 7.0; CI: 2.49-19.4; p = <0.001) in the placebo group when compared to the betamethasone group and also significantly higher (RR:4.0; CI: 1.86-26.03; p= 0.01) in the placebo group when compared to the dexamethasone group. Conclusion: Antenatal corticosteroids may decrease the need for neonatal resuscitation at birth in late preterm neonates. Funding: The research was funded by the Tertiary Education Trust Fund (TETFUND) of Nigeria. Trial registration: ClinicalTrial.gov, NCT03446937.

Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012-2019: a secondary data analysis.

BACKGROUND: Nigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. METHODS: This retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019. RESULTS: Cumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases. CONCLUSIONS: Sokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

Extent of spongiofibrosis and length of strictures: Findings at sonourethrography and urethroplasty.

INTRODUCTION: The purpose of this study was to diagnose urethral stricture and to determine the extent of spongiofibrosis as well as the length of stricture using sonourethrography and compare it with intraoperative findings. PATIENTS AND METHODS: It was a cross sectional observational study from September 2017-August 2018. All patients who presented with urethral stricture, scheduled for urethroplasty, and consented to the study were enrolled. The extent of spongiofibrosis and length of strictures were determined at sonourethrography and subsequently at urethroplasty. Sensitivity, specificity, positive predictive value and negative predictive values of sonourethrography in the determination of length of stricture was done. Spearman correlation coefficient(r) was used to describe the association between the extent of spongiofibrosis found at sonourethrography and at urethroplasty. RESULTS: A total of 84 patients were evaluated during the study period. The median age at presentation was 45years. 81% of the patients had moderate spongiofibrosis on sonourethrography. There was a significant correlation of 71.4% between the extent of spongiofibrosis on sonourethrography and at urethroplasty. In evaluation for the length of strictures, sonourethrography had a sensitivity of 84.6% specificity of 82.7%, PPV of 68.7% and NPV 92.3%. CONCLUSION: Sonourethrography is a valuable tool in the evaluation of urethral strictures. Its radiation free readily available even in resource-poor settings and gives a good evaluation of extent of spongiofibrosis as well as the length of strictures. It's use in the preoperative evaluation of strictures may improve the outcome of the management of strictures.

Prevalence and Factors Associated with Neonatal Sepsis in a Tertiary Hospital, North West Nigeria.

CONTEXT: Neonatal sepsis is an important cause of morbidity and mortality of newborns, especially in developing countries. AIMS: Our study determined the prevalence of neonatal sepsis and its predisposing factors among neonates admitted in Ahmadu Bello University Teaching Hospital (ABUTH). SETTINGS AND DESIGN: This was a cross-sectional descriptive study conducted in ABUTH. SUBJECTS AND METHODS: The data were abstracted from the case notes of neonates admitted from May 2017 to May 2018. A pretested pro forma was used to abstract the data. STATISTICAL ANALYSIS USED: Odds ratios and multivariate logistic regression were used to determine the factors associated with neonatal sepsis among the study population. RESULTS: The prevalence of neonatal sepsis was 37.6%. Escherichia coli was the most commonly isolated organism. Neonates 0-7 days of age were 2.8 times less likely to develop neonatal sepsis than older neonates. Babies born with an Apgar score of <6 within the 1st min were 2.4 times more likely to develop neonatal sepsis than those whose Apgar score was higher. Neonates of mothers who had urinary tract infection during pregnancy were 2.3 times more likely to have had sepsis and those whose mothers had premature rupture of membranes were 4.6 times more likely. CONCLUSIONS: The prevalence of neonatal sepsis was high among the neonates studied. Neonatal and maternal factors were associated with sepsis in the neonates. These findings provide guidelines for the selection of empirical antimicrobial agents in the study site and suggest that a continued periodic evaluation is needed to anticipate the development of neonatal sepsis among neonates admitted.