Probable horizontal transmission of SARS-CoV-2 in an asymptomatic neonate: A case report

Introduction: Preterm delivery is of considerable concern to clinicians and researchers being a leading cause of infant morbidity and mortality in the industrialized countries and also contributes to substantial complications among survivors. Sub-Saharan Africa, including Nigeria accounts for significant proportion of preterm births, with over million deaths due to complication of prematurity. Objectives: The study aimed to determine the prevalence and associated morbidities of preterm deliveries at the University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria. Patients and methods: This is a retrospective review of neonates delivered before 37 completed weeks of gestation and admitted into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital, from 1st January 2008 to 31st December 2015. Results: There were 3435 admissions into the Special Care baby Unit (SCBU) during the 8 year period. Out of these 1129 were preterm babies giving a prevalence of 32.9%. Of the 1129 preterm babies managed in SCBU, 714 case records were retrieved and analyzed giving a retrieval rate of 63%. There were 372 (52.1%) males and 342 (47.9%) females; with the male to female ratio of 1:1.08. There were 17(2.3%) extreme low birth weight (1000-1499 g), 406 (56.9%) low birth weight (1500- 2499 g) babies. The range of admission weights was 700-2500g with mean of 1600±900g. Conclusion: The burden, complications and mortality from preterm newborns remain significant public health challenges to care givers in Nigeria

Oscillometric blood pressure reference values of African full-term neonates in their first days postpartum.

BACKGROUND: Knowing the normative blood pressure (BP) in a newborn baby is important in order to identify abnormal BP readings. This study was done to determine normative BP values of Nigerian newborns, using the 8100 Dinamap monitor. METHODS: Consecutive full-term neonates delivered in a tertiary centre in Nigeria were recruited for the study. The babies' systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressures were measured within the first four days after birth. RESULTS: A total of 473 babies were recruited for the study. The mean SBP, DBP and MAP readings on day 1 were 66.8 +/- 7.7, 38.5 +/- 6.3 and 47.9 +/- 6.3 mmHg, respectively. The day 1 SBP of babies > 4 kg were significantly higher than those who weighed < 2.5 and 2.5-4 kg (p = 0.01, p = 0.05), respectively. CONCLUSION: This study provided current normative SBP, DBP and MAP values for Nigerian neonates. The BP readings compared with their Caucasian counterparts.

In vitro activity of human milk against the causative organisms of ophthalmia neonatorum in Benin City, Nigeria.

The aim of the study was to evaluate the in vitro activity of term human milk on the organisms of Ophthalmia neonatorum and was a prospective study of consecutive neonates with the organism. The study was undertaken in a special care baby unit/lying-in ward in Benin City, Nigeria, and consisted of 22 neonates with ophthalmia neonatorum. Bacterial organisms grown on blood agar, were obtained from eye swabs of neonates with ophthalmia neonatorum. Inoculated isolates were incubated with known antibiotic discs, term colostrum, and mature milk. Bacteria were isolated in 77 per cent (17/22) of the neonatal eye swabs, 59 per cent of which were Staphylococcus aureus and 41 per cent coliform organisms. Sensitivity of Staphylococcus aureus to gentamicin was 100 per cent and for coliform organisms 42 per cent. The sensitivity of Staphylococcus aureus to term colostrum was 50 per cent and to mature milk 0. Coliform organisms had a sensitivity of 57 per cent to colostrum and 28 per cent to mature milk. The zone of inhibition of colostrum against Staphylococcus aureus and coliform organisms was between 3 and 5 mm, while for mature milk, there was partial or no inhibition, respectively, to coliform organisms and Staphylococcus aureus. The mean duration of inhibition was 6 hours for colostrum and 3 hours for mature milk. Colostrum has about half the in vitro inhibitory activity of gentamicin (recommended as a first line topical agent, based on the bacteriological sensitivity of this study) against Staphylococcus aureus and coliform organisms. The inhibitory activity of colostrum is > or = 50 per cent against Staphylococcus aureus and coliform organisms for a mean duration of 6 hours. Mature milk had no inhibitory activity against Staphylococcus aureus and only 28 per cent inhibition, for a mean duration of 3 hours to coliform organisms.

Prevalence of malaria parasitaemia in transfused donor blood in Benin City, Nigeria.

In view of the problem of transfusional malaria, the prevalence of malaria parasitaemia in transfused donor blood was assessed. Blood film examination for malaria parasites on Giemsa-stained donor blood which was used for transfusion to neonates in Benin City, Nigeria was carried out over a 6-month period. Blood group O was the dominant blood type (17%). A high malarial parasite prevalence rate of 40% was noted in the transfused donor blood and Plasmodium falciparum was the dominant infecting species. All blood groups and rhesus factor types were infected with malarial parasites. There was no significantly increased malarial infection rate in any particular blood group type. The neonate, who is known to be immunologically naive, is at high risk of symptomatic malaria acquired through blood transfusion. All neonates who require blood transfusion should be given chloroquine sulphate soon after transfusion, at a dose of 5 mg/kg/day for 3 days, when the parasites are chloroquine-sensitive. In cases of chloroquine resistance, quinine sulphate or halofantrine hydrochloride is an acceptable alternative. Where feasible, donor blood screening for malaria should be carried out before transfusion to any neonate.

Clinical characteristics of neonatal malaria.

The clinical characteristics of 16 neonates with malaria parasitaemia diagnosed on Giemsa stained smears were documented during a 3-month rainy season period in a tropical African city. The prevalence of neonatal malaria was 8 per cent. Seventy-five per cent of these neonates had congenital malaria, 13 per cent transfusional malaria, and 13 per cent had acquired malaria. Plasmodium falciparum was found in all positive smears. Bacterial cultures of blood, urine, and cerebrospinal fluid were sterile. The predominant clinical features were those of fever (88 per cent), respiratory distress (57 per cent), pallor and anaemia (38 per cent each), hepatomegaly (31 per cent), and jaundice and diarrhoea (25 per cent each). Twenty-five per cent of the neonates were resistant to chloroquine sulphate; 19 per cent of the chloroquine resistant babies were also resistant to quinine sulphate 13 per cent of whom responded to halofantrine hydrochloride. One died a day after completing a full course of quinine, with a post-mortem blood smear showing no change in the density of parasitaemia.

Goldenhar syndrome (oculo-auriculo-vertebral dysplasia): report of two cases.

A report of two cases of oculo-auriculo-vertebral dysplasia (Goldenhar syndrome) from Benin City, Nigeria is presented. Both cases were seen in males with normal anthropometric parameters of head circumference, length and birth weight. The diagnosis was made in the neonatal period. Both babies had the consistent features of epibulbar dermiods, pre-auricular tags, and vertebral anomalies, though the lesions were seen on the left side of the body as against the expected right. Suddenly, within the first five weeks of life, both babies died of unknown cause.

Placental malaria and pregnancy outcome.

Malaria parasitemia was assessed in 312 placentae of singleton deliveries in Benin. The prevalence rate was 45.19%. The dominant infecting specie was Plasmodium falciparum. High density parasitemia of placental smear in 44.68% was associated with preterm delivery, low birthweight, intrauterine growth retardation and neonatal mortality. Placental histological diagnosis of malaria in 57.69% was more frequently associated with intrauterine growth retardation. Extraplacental parasitemia decreased but intraplacental parasitemia increased with gestational age.

Malaria parasitaemia in neonates with predisposing risk factors for neonatal sepsis: report of six cases.

In a study of neonatal malaria at the University of Benin Teaching Hospital, we documented the features of six neonates in an effort to highlight that the manifestations of malaria in the newborn cannot be readily distinguished from those of neonatal sepsis. Maternal peripartum fever, an important identifiable risk factor for neonatal sepsis, also featured prominently in the mothers of these babies. These mothers ingested pyrimethamine weekly in the course of their pregnancy. All six neonates were critically ill. Their cultures of blood, CSF and urine for bacterial pathogens yielded no growth and they were unresponsive to conventional antibiotics. The diagnosis of malaria should be considered, in spite of regular maternal ingestion of antimalarial prophylaxis with pyrimethamine, in critically ill neonates in malarious areas. All six neonates responded satisfactorily to oral doses of chloroquine. We therefore suggest that a blood film for malaria parasites be included in screening for neonatal sepsis as part of the initial work-up.