Retrospective assessment of neonatal morbidity and mortality in the special care baby unit of a private health facility in Benue State, North Central Nigeria

Background: Newborn morbidity and mortality have remained unacceptably high in developing countries despite consistent efforts at controlling the scourge. Unlike in developed countries where neonatal mortality rate ranges between 1 and 5 per 1000 live births, average neonatal mortality rate in Nigeria is 36 per 1000 live births. The majority of the causes of death are largely preventable with timely low cost interventions. This study was structured to determine the pattern of morbidity and mortality amongst babies admitted in the Special Care Baby Unit of Madonna hospital Makurdi, Nigeria.Methods: The records of neonates admitted into the Special Care Baby Unit (SCBU) over a tenyear period (2005-2015) were retrospectively reviewed. Information obtained included the sex, age at admission, gestational age, birth weight, reasons for admission and outcome of treatment.Results: A total of 1,121 babies were admitted during the period under review. The male female ratio was 1.2:1.The majority of the babies were aged between 2-7 days with a mean 6.17.+ 7.01 The mean weight on admission was 2807+907g. Neonatal sepsis, jaundice, low birth weight and birth asphyxia were the most common morbidities. The overall mortalityrate was 14.1%; however, proportionate mortality due to low birth weight was highest (26.4%), followed by tetanus (23.5%), asphyxia (20.8%), Respiratory tract infection (13.8%), meningitis (13.3%), sepsis (10.3%), jaundice (9.6%), and diarhoea (4.0%)Conclusion: Neonatal mortality rate in the study was high. The major causes of admission are preventable. Strengthening perinatal care, emergency obstetric care services and neonatal resuscitation skills are necessary to reduce the neonatal mortality

A Four-Year Retrospective Review of Very Low Birth Weight Babies Seen at the University of Abuja Teaching Hospital, Abuja, Nigeria.

AIMS AND OBJECTIVES: To review the outcome of very low birthweight infants admitted into the Special Care Baby Unit (SCBU) of University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria. METHODS: A retrospective review of medical records of very low birthweight (VLBW) babies seen at the SCBU of UATH over a 4-year period from April 2006 to March 2010, was undertaken. Data were obtained from patients' folders and analyzed. RESULTS: Overall survival was 60.8%. Survival of infants with birth weight below 1000 grams was 26.8% compared to 66.4% for those between 1000 and 1499 grams. The main determinants of survival were birth weight (p< 0.0001) and gestational age (p = 0.0106). Other predictors of outcome were development of features of respiratory distress syndrome within hours of delivery, recurrent apnoea, drainage of liquor of more than 18 hours before delivery, hyperkalaemia, lack of antenatal care and being born-before-arrival (outborn). CONCLUSIONS: Survival rate is low compared to values from other communities in developing countries but better than values from many centres in Nigeria. Timely and effective management of apnoea, respiratory distress syndrome and prevention of extremely low birthweight (ELBW) deliveries through adequate antenatal care are required to improve on the current survival rate.

Congenital long-QT syndrome in a Nigerian child: a case report.

CASE REPORT: We describe the clinical manifestation and the challenges of diagnosing Long QT syndrome, type 1 (LQTS1), in an 8-year old girl who presented at the Paediatric Cardiology Clinic with syncopal attacks following dancing and excitement. Her initial ECG showed normal QT interval of 380msec (QTc=440 msec), but later, increased to 410 msec (QTc=520 msec) following epinephrine challenge test. CONCLUSION: The challenges with the diagnosis of LQTS1 in children in resource-constrained setting and the need for vigilance in children with syncopal attacks and other cardiac events with normal QT intervals on an electrocardiogram are thus highlighted.

Neonatal hypothermia in sub-Saharan Africa: a review.

BACKGROUND: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization's recommendation of maintenance of warm chain in newborn care, hypothermia continues to be a common neonatal condition which has remained under-recognized, under-documented, and poorly-managed. OBJECTIVE: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. MATERIALS AND METHODS: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase, Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia,' 'Cold stress in newborn' 'thermal care of the newborn,' 'neonatal thermogenesis,' 'neonatal cold injury,' among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. RESULT AND CONCLUSION: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns.

Neonatal Hypothermia in Sub-Saharan Africa: A Review

Background: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization's recommendation of maintenance of warm chain in newborn care; hypothermia continues to be a common neonatal condition which has remained under-recognized; under-documented; and poorly-managed. Objective: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. Materials and Methods: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed; Embase; Ajol; Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia;' 'Cold stress in newborn' 'thermal care of the newborn;' 'neonatal thermogenesis;' 'neonatal cold injury;' among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. Result and Conclusion: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty; home delivery; low birthweight; early bathing of babies; delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns

Congenital gangrene of the extremities in a newborn.

Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting.

Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria.

OBJECTIVES: The study aimed at identifying the risk factors for neonatal septicaemia in Zaria. PATIENTS AND METHODS: Consecutive newborns admitted into the Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria with the presumptive test diagnosis of neonatal septicaemia between 25 May, 2004 and 31 May, 2005 were studied. History of events in the antenatal and neonatal periods was obtained and physical examination was done. Blood, urine, cerebrospinal fluid and swabs of body discharges were taken for culture and sensitivity studies. The data were analysed using Epi Info version 6 software. Associations were tested using Chi square, with Yates correction, or Fisher's exact tests where appropriate, while statistical significance was set at p < 0.05. RESULTS: A total of 211 neonates, consisting of 69 in-born and 142 out-born infants were studied. There were 122 (57.8%) males and 89 (42.2%) females; giving a male: female ratio of 1.4:1. Seventy-five (35.5%) of the newborns had bacteriologically proven septicaemia consisting of 54 (38.0%) of the outborn and 21 (30.4%) of the inborn babies (p = 0.3535); 42 males and 33 females (p = 0.8011). The male: female ratio of newborns with culture-proven septicaemia was 1.2:1. The predisposing factors that were associated with culture-proven septicaemia were lack of antenatal care (p = 0.0234), prolonged rupture of membranes (p = 0.0085), prolonged labour (p = 0.0032), preterm delivery (p = 0.0125) and perinatal asphyxia (p = 0.0078). CONCLUSION: The risk factors in neonates with septicaemia in this study emphasise the need for timely improvement in the implementation of existing public health strategies.

Pattern of neurological disorder presenting at a paediatric neurology clinic in Nigeria.

BACKGROUND: Neurological diseases account for more than 20% of the world's disease burden with majority of affected people living in Africa. However there is a paucity of literature on neurological disease in Africa. METHODS: A retrospective review of 114 children with neurological problem seen at a paediatric neurological clinic in a 2-year. RESULTS: Delayed developmental milestone, convulsion and inability to walk were the 3 most common reasons for referral to our Paediatric neurology clinic. Cerebral palsy (55.3%), Seizure disorder (26.3%) and postmeningitic complications (6.2%) were the common neurological disorder seen at our neurology clinic. The Paediatric outpatient department (POPD) of our hospital was the main source of referral for most cases (83.2%) and 71.1% of all patients resides within Zaria metropolis. The default rate from follow-up was higher among children with cerebral palsy compared to children with seizure disorder (58.7% vs. 13.3%, P < 0.001). CONCLUSION: Lack of adequate facilities for proper rehabilitation of children with cerebral palsy could have been the main reason for the high default rate from follow-up.