Cord Blood Thyroid Stimulating Hormone Values in Healthy Term Babies delivered at Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeastern Nigeria.

BACKGROUND: Congenital hypothyroidism is one of the most common preventable causes of mental retardation and clinical manifestations are often subtle or absent at birth and hence the need for screening. Implementation of newborn screening requires local normative values. OBJECTIVES: To determine the normative values of cord Thyroid Stimulating Hormone (TSH) among term babies in Bauchi, Northeast Nigeria and compare it with that from other centers in Nigeria. METHODOLOGY: Cord blood samples from 200 term babies were analyzed for TSH by Fluorescence Immunoassay technique in this descriptive cross-sectional study. A cut-off of >20 µIU/ml was used for recall. The mean and range were determined and compared with those of previous local studies using t-test. Impact of some maternal and infant factors on TSH was also assessed. RESULTS: The overall mean (SD) cord TSH was 3.74 (±1.99) µIU/ ml and the range was 0.73 to 15.22 µIU/ml (2.5th to 97.5th centile) and none had TSH > 20 µIU/ml and hence our recall rate was 0%. The mean cord TSH was comparable to that reported by a lone local multicenter study (p = 0.120) but significantly different from that of 3 other local studies (p < 0.001). There was also no significant difference between the means of different gender, birth weight groups, mode of delivery, socio-economic classes, maternal age and parity. CONCLUSION: The Cord blood TSH level of most term newborn in Bauchi, similar to other Nigerian studies, is < 10 µIU/ml with a few but significant percentage recording cord TSH level > 10 µIU/ml. Gender, birth weight, mode of delivery, socio-economic class, maternal age and parity were not significantly related to cord TSH level. The mean blood TSH values from different studies across the country tend to vary based on the assay technique. We recommend a nationwide multicenter study with a much larger sample size, lower cutoff value for recall and a unified sample processing laboratory if national normative values are to be developed.

BACKGROUND: L'hypothyroïdie congénitale est l'une des causes évitables les plus courantes de retard mental et les manifestations cliniques sont souvent subtiles ou absentes à la naissance, d'où la nécessité d'un dépistage. La mise en œuvre du dépistage néonatal nécessite des valeurs normatives locales. OBJECTIFS: Déterminer les valeurs normatives de l'hormone stimulatrice de la thyroïde (TSH) du cordon chez les bébés nés à terme à Bauchi, Nord-Est du Nigeria et les comparer à celles d'autres centres du Nigeria. MÉTHODOLOGIE: Des échantillons de sang ombilical de 200 bébés nés à terme ont été analysés pour la TSH par la technique d' étude descriptive transversale. Un seuil de >20 µUI/ml a été utilisé pour le rappel. La moyenne et l'intervalle ont été déterminés et comparés avec ceux des études locales précédentes en utilisant le test t. L'impact de certains facteurs maternels myet infantiles sur la TSH a également été évalué. RÉSULTATS: La moyenne globale (SD) de la TSH du cordon était de 3,74 (±1,99) µIU/ml et l'intervalle était de 0,73 à 15,22 µIU/ml (2,5 à 97,5 centiles) aucun n'avait une TSH > 20 µIU/ml et donc notre taux de rappel était de 0%. La moyenne de TSH au cordon était comparable à celle rapportée par une seule étude multicentrique locale unique (p = 0,120) mais significativement différente de celle de 3 autres études locales (p < 0,001). Il n'y avait pas non plus de différence significative entre les moyennes des différents sexes, groupes de poids de naissance, mode d'accouchement, classes socio d'accouchement, les classes socio-économiques, l'âge maternel et la parité. CONCLUSION: Le niveau de TSH dans le sang de cordon de la plupart des nouveau-nés à termede la plupart des nouveau-nés à terme à Bauchi, comme dans d'autres études nigérianes, est < 10 µUI/ml mais significatif, enregistrant un niveau de TSH du cordon > 10 µIU/ml. Le sexe, le poids à la naissance, le mode d'accouchement, la classe socio-économique maternelle et la parité n'étaient pas significativement liés au taux de TSH au cordon. Le site valeurs moyennes de la TSH sanguine provenant de différentes études dans le pays ont tendance à varier en fonction de la technique de dosage. Nous recommandons une étude nationale multicentrique avec une taille d'échantillon beaucoup plus grande, une valeur seuil pour le rappel et un laboratoire de traitement des échantillons unifié si des valeurs normatives nationales doivent être développées. Mots clés: Sang de cordon, Hormone de stimulation thyroïdienne, Bébés à terme.

Evaluating Ultrasound Determined Thyroid Volume as a Predictor of Newborn Thyroid Hormone Function.

BACKGROUND AND OBJECTIVES: Congenital hypo-thyroidism is a cause of intellectual and developmental disabilities in the newborn. Early screening and prompt treatment can prevent the devastating outcomes of congenital hypothyroidism. The disease burden of congenital hypothyroidism in Nigeria is higher than in many parts of the world. Using ultrasound, the authors sought to determine the normal mean thyroid gland volume in newborns and establish the thyroid gland volume as a predictor of thyroid hormone function in the newborn. METHODS: This was a descriptive cross-sectional study. Healthy newborns had their length and weight measured, thyroid ultrasound scan performed, and a blood sample taken for thyroid-stimulating hormone values. RESULTS: The mean total thyroid volume was 0.51cm3 ± 0.25. The thyroid volume of the right lobe (mean volume= 0.27cm3 ± 0.13) was significantly larger than the volume of the left lobe (mean volume =0.24cm3 ± 0.12) (p<0.001). The thyroid-stimulating hormone (TSH) values ranged from 1.36µIU/ml to 35.03µIU/ml with a mean value of 7.73µIU/ml ± 7.04. There was no significant correlation between the thyroid volumes and the TSH of the newborns. CONCLUSION: This study determined the mean thyroid volume in newborns. There was no significant correlation between the thyroid volumes and the TSH values of the newborns implying that the thyroid gland volume is not a reliable predictor of thyroid hormone function. Newborn, Ultrasound.

PREVALENCE OF BACTERAEMIA AMONGST CHILDREN WITH FEBRILE SEIZURES AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

BACKGROUND: Febrile seizures are common among children and these are known to result from the diverse aetiological factors, known to cause fever in children. OBJECTIVES: To determine the prevalence of bacteraemia amongst children with febrile seizures at the children's emergency room of the University College Hospital, Ibadan, Nigeria. METHODOS: This was a prospective study involving 147 children who were presented with febrile seizures over a period of 13 months at the University College Hospital Ibadan. They all had their blood cultures sample taken under aseptic conditions. Other investigations performed on them included a packed cell volume, full blood count and blood film for malaria parasite. RESULTS: A total of 83 males and 64 females with febrile seizures were studied. Their ages ranged from 4 to 60 months with a mean age of 26.35 + 13.76 months. Bacteraemia was diagnosed in 32(21.8%) of the cases. The predominant organism isolated from the blood of these patients was Staphylococcus aureus. CONCLUSION: Bacteraemia is a frequent finding in children with febrile seizures hence, it may be beneficial to carry out blood culture in such children on the suspicion of a probable bacterial infection.

Comparative evaluation of carotid intima media thickness in paediatric type 1 diabetic children and healthy children in Ibadan and Lagos, Nigeria

Patients with type 1 diabetes are at greater risk of cardiovascular disease and atherosclerosis. Carotid in-tima­media thickness (CIMT) measured by ultrasound is a marker of atherosclerosis and can predict future cardiovascular events.The aim of this study was to measure the CIMT in paediatric type 1 diabetes patients in Ibadan and Lagos and compare results with the CIMT of non-diabetic healthy control children. Carotid ultrasound was performed and CIMT measured in 70 subjects (35 diabetic patients and 35 non-diabetic controls matched for age and sex). Mean age was 12.8±3.2 years. A slightly higher, but non-significant mean CIMT was seen in diabetic cases: mean values in type 1 diabetes patients were 0.475±0.068 and 0.476±0.069 (right and left respectively) while in controls, mean values were 0.467±0.064 and 0.468±0.054 (p=0.618 and 0.575 respectively). The CIMT in both groups correlated positively with age and body mass index (BMI). Significantly higher mean CIMT values were seen in males with type 1 diabetes on both sides. However, there was no significant correlation between CIMT and duration of illness, insulin dosage, or blood pressure. CIMT is a safe and convenient measurement, which may be helpful in predicting an increased risk of future cardiovascular disease in children with type 1 diabetes

Charge syndrome in a Nigerian infant: a rare genetic disorder.

BACKGROUND: Charge syndrome is a rare genetic disorder that arises during early fetal development and affects multiple organ systems. Diagnosis is largely clinical. Mutation at the CHD7 gene located on Chromosome 8 has been identified in a great number of patients reviewed in different parts of the world. Survival depends on the intensity of the medical management as well as an early aggressive approach to the feeding adaptation in these children. CASE REPORT: We report a case of a 42 day old baby with clinical features in keeping with Charge syndrome. He was a product of a full-term uneventful pregnancy period delivered to non consanguineous apparently healthy parents. Two older siblings were normal. He developed respiratory distress shortly after birth. Multiple abnormalities were identified at birth which included genital, ear, eye and cardiovascular as well as skeletal abnormalities. Genetic testing was not carried out due to cost. Child was managed by a multidisciplinary team. Main problems were those of sepsis and feeding adaptation. He later succumbed to death after a month on admission. CONCLUSION: This is the first case of Charge syndrome reported in Nigeria. It is a rare, multisystemic condition with grave health implications and early diagnosis and appropriate management could reduce morbidity and prevent mortality. This report is to increase awareness of this rare condition and to promote better identification and intervention of similar presentation in future.

A typical presentations of hypothyroidism and associated problems in Ibadan, Nigeria.

BACKGROUND: Hypothyroidism can present atypically making its recognition difficult especially in resource limited settings. CASE PRESENTATION AND MANAGEMENT: Two children presented with atypical features of hypothyroidism with resultant delay in diagnosis. Patient I presented with persistent respiratory distress, facial swelling and recurrent syncopal attacks. Cardiovascular examination was normal except for pulmonary hypertension. He did not respond to conventional supportive therapy and hypothyroidism was discovered much later. Patient II was a seven month old male infant with abdominal swelling, bilateral pitting leg oedema, poor weight gain and delayed developmental milestones. Examination revealed ascites and pericardial effusion. He was being managed for protein energy malnutrition until he was found to have hypothyroidism and was successfully managed with L thyroxin. CONCLUSION: A typical presentations of hypothyroidism in resource limited settings can result in delay in diagnosis and treatment which can lead to unnecessary morbidity and mortality. High index of suspicion and expertise are therefore required.

Type 1 diabetes mellitus in a known sickle cell anaemia patient: a rare combination in Nigeria.

BACKGROUND: Sickle cell anaemia is a very common disease condition in Nigeria. Its co-existence with type 1 diabetes mellitus is however rare, with only a few cases having been reported in literature and only two children have been reported from Nigeria. The genetic basis for this has not been fully reviewed. This case represents one of the few documented of both type 1 diabetes mellitus (T1DM) and homozygous sickle cell disease co-existing in an individual. More research is necessary to identify the factors that influence this co-morbidity and its effects on disease progression and patient management. CASE REPORT: Q. O, a ten year old girl presented in October 2011 with 9 year history of recurrent bone pains, yellowness of the eyes and poor growth. She also had a short history of polyphagia, polydipsia and polyuria. Haemoglobin electrophoresis showed SS while a random plasma glucose done at least twice was greater than 200 mg/dl. There was no ketosis nor did she have any other adverse complications. She is currently being managed as a case of sickle cell haemoglobinopathy with T1DM. Her management has been hampered by severe financial constraints. CONCLUSION: This report seeks to increase the awareness of this rare co-existence in this environment, as well as to highlight the antecedent challenges in management.

Penile size in healthy Nigerian newborns: country-based reference values and international comparisons.

AIM: To establish normal reference values for penile size in Nigerian newborn boys and to compare those values with standards from other populations. METHODS: A total number of 261 healthy newborn boys delivered at gestational ages of 28 weeks or more were enrolled in the study. Penile lengths and widths were measured within 72 h of birth. RESULTS: The mean (±SD) penile length in the 261 Nigerian males studied was 3.4 ± 0.48 cm, while the mean mid-shaft diameter was 1.2 ± 0.14 cm. Compared with data from other populations, Nigerian newborn boys had similar penile sizes to those reported for US Caucasian boys (mean 3.4 cm), but significantly greater penile sizes than those reported for boys from China and Hong Kong (mean 3.0 and 3.1 cm, respectively; both p < 0.001). There was a slight, but significant, difference in size between Nigerian and Malaysian boys, with Malaysian boys having greater penile sizes (mean 3.5 cm; p < 0.05). CONCLUSION: A Nigerian newborn with a penile length of <2.39 cm can be considered to have a micropenis.

Paediatric endocrine disorders at the university college hospital, ibadan: 2002 - 2009.

BACKGROUND: Until recently, most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis. OBJECTIVE: This study aims at defining the burden of paediatric endocrine disorders in Ibadan. SUBJECTS/METHODS: A review of records of children who presented at University College Hospital, Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out. RESULTS: During the eight-year period, a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50%) males and 37(39.4%) females, and in 10(10.6%) of them, had genital ambiguity at presentation. Patients' ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35%) patients were malnourished with weight less than 80% of the expected weight for age and only 9% were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4% of patients; Diabetes mellitus was diagnosed in 12.8%, adrenal disoders in 10.6%, pubertal disorders in 5.3% and growth disorders in 4.3% of the patients. Thyroid disorders were present in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%). About 58% of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6% of these patients were lost to follow up, during the period. CONCLUSIONS: Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition.

Paediatric Endocrine Disorders at the University College Hospital; Ibadan: 2002 - 2009

Background: Until recently; most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis. Objective: This study aims at defining the burden of paediatric endocrine disorders in Ibadan. Subjects/Methods: A review of records of children who presented at University College Hospital; Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out. Results: During the eight-year period; a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50) males and 37(39.4) females; and in 10(10.6) of them; had genital ambiguity at presentation. Patients' ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35) patients were malnourished with weight less than 80 of the expected weight for age and only 9 were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4 of patients; Diabetes mellitus was diagnosed in 12.8; adrenal disoders in 10.6; pubertal disorders in 5.3 and growth disorders in 4.3 of the patients. Thyroid disorders were present in 6.4; obesity in 3.2 while the least common disorder was Diabetes insipidus (1). About 58 of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6 of these patients were lost to follow up; during the period. Conclusions: Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition

Pre-hospital management of febrile seizures in children seen at the university college hospital, ibadan, Nigeria.

BACKGROUND: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome. OBJECTIVES: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria. METHODS: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded. RESULTS: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socio-economic class of the caregivers (P=0.008). CONCLUSIONS: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortality associated with febrile seizures in the locality.