Neural tube defects in a university teaching hospital in southern Nigeria: trends and outcome.

BACKGROUND: There has been some increase in the proportion of Neural Tube Defects (NTD) admitted in the University of Port Harcourt Teaching Hospital recently. Fora largely preventable birth defect, this increase is both unnecessary and unacceptable. This study was undertaken to describe the admission patterns and outcome of neural tube defects in University of Port Harcourt Teaching Hospital. METHODS: A retrospective study of babies with neural tube defects who were admitted into Special Care Baby Unit (SCBU) of the University of Port Harcourt Teaching Hospital from 1st May 2002 to 30th April 2005 was carried out. Their case notes were retrieved and information on the sex, maternal drugs during pregnancy, type of defect and associated malformations, prenatal diagnosis, management and outcome were obtained. The admission rate and the incidence were then calculated. RESULTS: There were 2891 total admissions (1691 males and 1200 females) during the study period of which 37 (1.3%) were neonates with NTD. Of those with NTD, 25 were males and 12 female giving a male to female ratio of 2:1 (statistically not significant p = 0.242.) The total hospital delivery at the study period was 7,388 of which 7 had NTD giving an incidence of 0.95/1000 deliveries. The commonest type of NTD was myelomeningocoele in 31 (83.8%), and the commonest site was the thoracolumbar region (93.5%). Frontal encephalocoele was seen in 6 (16.2%). All the babies with myelomeningocoele presented with flaccid paraparesis and were incontinent of both urine and faeces. Seventeen of the babies had only spina bifida while 14 had additional defects including talipes equinovarus (8), hydrocephalus (2), frontal encephalocoele (1), and multiple malformations (3). Ten babies (27%) died, three of them after surgery. All the mothers received folic acid from the second trimester of pregnancy, but none did before pregnancy. CONCLUSION: The Incidence of NTD is on the increase in our environment. There is need to formulate/implement the policy of preconceptional folic acid therapy for all woman of childbearing age as a preventive measure

Seasonality and other variation trends in birth weights of 4000g and above: A preliminary report from the University of Port Harcourt Teaching Hospital, Nigeria.

BACKGROUND: Anecdotal evidence appears to suggest a progressive increase in the proportion of large babies born at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. The objective of this study is to examine retrospectively the profile of birth weights at the UPTHover a defined time frame. METHODS: The birth weights of all babies born in the hospital from January 1, 1990 to December 31, 1999 were analyzed with the focus on weights = 4000g. The ten-year period was elongated into 20 six-monthly observation points and the periodic fluctuations in the proportion of birth weights = 4000g smoothed by using exponentially weighted moving averages with a weighting factor of 0.18. Seasonal variations in rates of birthweight = 4000g were calculated using Ratchet Circular Scan Test for a short seasonal peak. Proportions were compared using chi-square statistic. RESULTS: Fourteen thousand three hundred and seven birth weights were recorded; 7111 males and 7196 females. Nine hundred and four (12.7%) and 434 (6.0%) of males and females respectively were 4000g and above. There was a sustained increase in the proportion of the = 4000g category during the observation period although the slope was steeper among the males (slope with [95% Confidence Interval] for males = 0.4131 [0.3213 to 0.5050] and for females 0.1801 [0.05565 to 0.3045]. There was a significant 3-month peak August to October of males only of birth weight = 4000g, (3-month peak; August to October, 30.3% of events. Test Statistic 3.46, p < 0.005). CONCLUSION: There has been a steady increase in the proportion of babies of birth weight =4000g at the UPTH in the ten-year period studied. This trend could be potentially dangerous for both mother and baby; therefore the authors believe it would be a good idea to carry out a prospective investigation along similar lines but using a much broader study base.

Blood transfusion therapy in neonates admitted into the Special Care Baby Unit (SCBU) of University of Port Harcourt Teaching Hospital, Port Harcourt.

BACKGROUND: Blood transfusion is associated with potential risks and adverse effects; it is therefore pertinent to ensure that it is given only when it is indicated. The objective of this study is to determine the rate and the indications of blood transfusion in neonates admitted into the Special Care Baby Unit (SCBU) of University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. METHOD: A prospective study of Neonates admitted into SCBU between January 1st 2003 and December 31st 2004 and who had blood transfusion during their hospitalization was carried out. RESULTS: Preterm babies are more likely to be transfused and are also more likely to receive multiple blood transfusions. Severe neonatal jaundice and severe anaemia are the commonest indication for blood transfusions in the neonates. Exchange blood transfusions (EBTs) were utilized more often than top up transfusions even among preterms. Adverse events were seen more in those that had EBT CONCLUSION: The rate of blood transfusion is still very high among neonates. Concerted efforts should be made to prevent severe neonatal jaundice and severe anaemia and thus reduce the rate of blood transfusion.

A seven-year audit of a diarrhoea training unit (DTU) in Port Harcourt, Nigeria.

The Diarrhoea Training Unit [DTU] of the University of Port Harcourt Teaching Hospital in Nigeria was established in 1991 and has, in addition to treating cases, been involved in training medical students, paediatric residents, health workers and mothers caregivers on correct case management of diarrhoeal disease. The accomplishment of the Unit over a defined time frame, January 1993 to December 1999, was evaluated by employing predetermined indicators and the data were analyzed by using the Statistical Package PEPI [Computer Programs for Epidemiologic Analysis Version 2.07a]. Eight thousand, four hundred and eighty-six cases (4557 males and 3929 females) of acute diarrhoea were treated. Those with severe dehydration were eleven times fewer in 1998 and eight times fewer in 1999 than in 1993. The number of Oral Rehydration Salts (ORS) sachets used in the Unit increased from 3064 in 1993/94 to 17,549 in 1998/99. There was no reduction in the number of cases treated, but the case-fatality rates dropped from 6 per 1000 in 1993 to 0.6 per 1000 in 1999 [likelihood ratio chi2 = 9.874, p = 0.02]. There was a significant reduction in the proportion of patients with bloody stools towards the end of the observation period [chi2(trend) = 82.60, 1 df, p = 0.000 (1.00E-19)]. These results indicate some positive impact on the severity of diarrhoea in the area, but preventive measures should now constitute the main thrust.

Social-environmental influences on the occurrence of neonatal tetanus in some riverine communities in Nigeria.

PIP: The factors associated with neonatal tetanus occurrence were rank ordered in a survey of 1867 children from a community in Nigeria with a previously documented high prevalence of this infection. The study, restricted to children born in 1992, 1993, and 1994, was conducted in the first 2 weeks of 1995. There were 28 cases of neonatal tetanus, for a rate of 15/1000 live births. Although cases and controls lived under similar social and environmental circumstances, three factors emerged as significant risk factors for neonatal tetanus: 1) lack of maternal education to the secondary level, 2) lack of antenatal care, and 3) delivery in a nonmedical establishment. Moreover, these three factors were linked. Mothers educated beyond the primary school level were more likely to understand the importance of antenatal care and to receive tetanus toxoid vaccination; if they received antenatal care, they were more likely to deliver in a medical establishment. Thus, eradication of illiteracy among women in Nigeria represents a priority in the effort to prevent neonatal tetanus.^ieng

Determinants of tetanus toxoid immunization of parturient women: a community-based study in Rivers State of Nigeria.

A community-based study carried out in the Rivers State of Nigeria on tetanus toxoid immunization status of parturient women showed a complete, partial and no coverage status of 41.2, 17.0 and 41.8 per cent respectively of women surveyed. Formal education to the secondary school level was very strongly associated with complete coverage status (p < 0.001). Also of importance was the peculiar geographical terrain of the state since the place of obstacles as a negative factor was significantly more pronounced among the riverine community (p < 0.001). Generally, communities in the state will require more logistics support than elsewhere in the country for any intervention measure to have an appreciable impact and on the long term the institution of measures aimed at raising the literacy level of the population as a whole will bring about overall improvement in the vaccine coverage in the state.

Anthropometric indices in singleton term neonates and their possible value in predicting some metabolic problems: a preliminary study.

We studied possible sources of variations in selected anthropometric indices and their relationship to neonatal metabolic problems in seventy-four singleton neonates born at an approximate gestation of 40 weeks, by selected anthropometry. There were significant differences particularly in values obtained for birth weight, mid upper arm circumference, chest circumference and the Ponderal Index. At the moment it is not possible to set discriminant values on any of the anthropometric indices as this will require a much larger sample size, however the authors believe that the use of anthropometry in predicting metabolic problems in neonates has some potential and serial measurements of particularly chest circumference, mid upper arm circumference and the Ponderal Index could form the basis of future studies.

Neonatal tetanus in Port Harcourt.

In a previous study on neonatal tetanus (NNT), we provided information on clinico-epidemiological data and reported a case-fatality rate of 60.3%. The present report covers a 7-year period, January 1984 to December 1990, and amongst others, focuses on tetanus toxoid vaccine (TT) coverage of pregnant women. The subjects were those with a diagnosis of NNT and other neonatal admissions. Total neonatal admissions, NNT admissions, neonatal deaths, and NNT deaths were: 4,315, 471, 727, and 221 respectively. The overall NNT case-fatality rate was 46.9%. The highest NNT admission rate was in the third quarter of 1984, with a significant decline subsequently except for the increase in 1989. The neonatal tetanus rate began dropping appreciably from 1988 although less than 10% of the mothers in 1990 received two doses of TT. The improper immunization of the mothers during pregnancy with TT is worrying particularly several years into the Expanded Programme on Immunization (EPI), more so as the experience is not unique to Port Harcourt. We suggest intervention at the community level, operational research, and ethnographic studies to determine possible underlying factors to be carried out in all health zones of the country.

Childhood convulsions: a hospital survey on traditional remedies.

A study of one hundred and thirty five children with convulsions admitted in the University of Port Harcourt Teaching Hospital, Nigeria over a 15-month period, October 1986 to December 1987 showed that 65 (48%) of the children received some traditional remedy at home prior to presentation in hospital. Crude oil and palm kernel oil either singly or in combination were the most commonly administered remedies. The central nervous system was more affected by remedies containing crude oil than others (P < 0.05). Administration of cow's urine to convulsing children, reported from other parts of Nigeria, was not observed in the present study and would appear to be uncommon in this part of the country.

Mortality in infants of birthweight 2500g and above: a hospital-based review in Port Harcourt, Nigeria.

In order to study mortality patterns among full-grown infants, the records of all babies of birthweight 2500g and above admitted into the Special Care Baby Unit of the University of Port Harcourt Teaching Hospital, Nigeria, over a three-year period were retrieved and examined. There was a total of 1519 admissions during the period, 878 (58%) of whom weighed 2500g and above, and 39 of these full-grown babies died. Common associated findings among infants who died were birth asphyxia and congenital malformations. Furthermore birth asphyxia occurred more commonly among the large and mature babies and was a significant cause of first week deaths. It should be possible to reduce the magnitude of wastage of this group of babies by encouraging pregnant women to make use of the available facilities. High risk pregnancies should be recognised promptly and above all there should be intimate cooperation among all those involved in delivery and care of the newborn; paediatricians, midwives, obstetricians and anaesthetists.

Survival in very low birthweight infants at the University of Port-Harcourt Teaching Hospital, Nigeria.

Between January 1984 and December 1987, 1509 singleton neonates were admitted into Special Care Baby Unit at the University of Port Harcourt Teaching Hospital; 29(1.9%) of these were Extreme Low Birthweight (ELBW), 86(5.7%) were Very Low Birthweight (VLBW), 406(26.9%) were Low Birthweight (LBW) and 988 (65.5%) were Normal Birthweight (NBW) infants. Survival rates in the four categories were 10.3%, 46.5%, 89.2% and 94.7% respectively. Factors which significantly influenced survival in the VLBW infants included higher mean birthweight (p less than 0.01) longer mean gestation (p less than 0.001) and lower incidence of birth asphyxia (p less than 0.02 with Yates's correction). Furthermore the survivors were significantly more mature for their gestation than those who died (p = 0.008, Fisher's Exact test). Care of the VLBW infant is not beyond the capabilities of Special Care Baby units in developing countries. In the light of our report, survival of Low Birthweight infants is a strong reflection of that of VLBW infants and survival of this category of babies could be improved by instituting general measures such as those aimed at reducing the incidence of LBW in the environment and by specific measures like carrying out prompt and effective resuscitation of the asphyxiated neonate and preventing sepsis.

PIP: A total of 1509 singleton neonates (849 males and 660 females) were admitted into the Special Care Baby Unit at the University of Port Harcourt Teaching Hospital in Nigeria between January 1984 and December 1987. Of these, 29 (1.9%) were extreme low birth weight (ELBW); 86 (5.7%) were very low birth weight (VLBW), 40 of whom survived; 406 (26.9%) were low birth weight (LBW); and 988 (65.5%) were normal birth weight (NBW) babies. Survival rates in the 4 groups were 10.3%, 46.5%, 89.2%, and 94.7%, respectively. Higher mean birth weight (p .01), longer mean gestation (p .001), and lower incidence of birth asphyxia (p .02 with Yates's correction) significantly more mature for their gestational age (p = .008, Fisher's exact probability test) than those who died. Among infants who survived, one each had idiopathic respiratory distress syndrome (RDS) and septicemia. Among the infants who died there were 2 cases of RDS and 1 each of aspiration pneumonia and septicemia. Survival of babies with birth weights under 1000 gm improved very little over the 4-year period, while the survival rates stayed constant at 90% in babies with birth weights of 1500 gm and above. The overall survival rate in the Unit improved from 86.1% in 1984 to 91.4% in 1987. There were relatively fewer cases of birth asphyxia in the VLBW category than in the rest of the babies resulting in better survival. The survival of LBW infants was distinctly reflected by that of VLBW infants whose survival could be improved by instituting measures such as prompt resuscitation of the asphyxiated neonate and prevention of sepsis.

Survival in very low birthweight infants at the University of Port-Harcourt Teaching Hospital; Nigeria

Between January 1984 and December 1987; 1509 singleton neonates were admitted into special care baby unit at the University of Port-Harcourt Teaching Hospital. Among them there were extreme low birthweight; very low birthweight and low birthweight and normal birthweight infants. Survival rates in the four categories were 10.3 per cent; 46.5 per cent; 89.2 per cent and 94.7 percent. Furthermore the survivors were significantly more mature for their gestation and lower incidence of birth asphyxia. Therefore each low birthweight has special care

Antenatal care and fetal outcome, especially low birthweight, in Port Harcourt, Nigeria.

A total of 820 singleton babies and 73 babies from multiple births were studied, all born in a 7-month period in the University of Port Harcourt Teaching Hospital. At birth, 8.9% of the singleton babies and 70% of those of multiple birth weighed less than 2500 g. Maternal factors significantly associated with increased incidence of low birthweight were antepartum haemorrhage, short stature, age and parity. However, the effects of these were nullified by antenatal care. Amongst the babies, the major contributory factor was intrauterine growth retardation, the cause of which in most cases was not apparent and was not affected by antenatal care. We suggest that a lot more attention be focussed on this category of low-birthweight babies.

Mortality in infants less than 2500 grammes birthweight admitted into a special-care baby unit in Port Harcourt, Nigeria.

PIP: Physicians studied the mortality rate of low birth weight (2500g) neonates admitted into a special care unit at a hospital in Port Harcourt, Nigeria between January 1984-June 1986. Care consisted of maintaining body temperatures, feeding, and preventing and treating infections. If required, oxygen was only administered in the incubator. 36.3% of all infants admitted to the special care unit during this period weighed 2500g. Those infants that died had lower birth weights, younger gestational age, lower temperatures on admission, and lower temperatures while in the unit than did surviving infants (p.001). Mortality was highest for those infants weighing 1000g (90%) and decreased with increasing birth weight (1000-1500g=51.1%; 1501-2000g=12.4%; and 2001-2499G=3%). In addition, the 1 and 5 minute APGAR scores were significantly lower among neonates who died than those who lived (p0.1 and p.001 respectively). Although infants who died had a significantly lower mean temperature on admission compared to those who survived, there was no significant difference in mean temperatures on admission between those born outside the hospital and those born in the hospital. Another risk factor was place of birth. Neonatal mortality was lower for those infants born in the hospital (9.7%) compared to those not born in the hospital (54%). Since Nigeria does not have specially designed ambulances with sophisticated transport incubators, this high mortality rate could be due to exposure to infection in transport. Nonetheless, it would be easier and cheaper to transfer the mother at risk than her ill neonate. These results demonstrate the importance of prevention of low birth weight rather than improving the facilities for intensive care which is beyond the reach of most developing countries.^ieng