Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 11 num. 2 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Making every baby count: Reflection on the Helping Babies Breathe Program to reduce birth asphyxia in sub-Saharan Africa</b>]]> <![CDATA[<b>The nursing crisis in paediatrics in South African state hospitals - an unaddressed problem</b>]]> <![CDATA[<b>Prevalence of and risk factors for cranial ultrasound abnormalities in very-low-birth-weight infants at Charlotte Maxeke Johannesburg Academic Hospital</b>]]> BACKGROUND. Periventricular-intraventricular haemorrhage (IVH) and cystic periventricular leukomalacia (cPVL) contribute to neonatal mortality and morbidity. Low birth weight and gestational age are among the risk factors for IVH and cPVL. OBJECTIVES. To assess how many very low birth weight (VLBW) infants had cranial ultrasound screening at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to determine the prevalence of cranial ultrasound abnormalities. To compare the characteristics and risk factors of those VLBW infants with cranial ultrasound abnormalities to those with normal cranial ultrasound findings. METHODS. This was a retrospective case-controlled study of infants <1 500 g admitted to CMJAH from 1 January 2013 to 31 December 2015. Cases were identified as infants with IVH or cPVL. Controls were matched 1:2 based on birth weight and gender. RESULTS. Only 55% (856/1 562) of VLBW infants had undergone cranial ultrasound screening. The final sample included 803 VLBW infants. IVH was identified in 26.7% of cases (n=215; 95% confidence interval (CI) 23.8 - 29.9) and 0.9% had cPVL (n=8; 95% CI 0.5 - 1.9). A total of 197 cases were identified and matched with 394 controls. Antenatal care attendance was lower in the cases (71% v. 79%; p=0.039). Sepsis, ventilation, metabolic acidosis and patent ductus arteriosus were all significantly higher in the cases. The use of antenatal steroids was significantly higher in the grades I - II IVH/no-IVH group v. grades III - IV IVH group (44% v. 25%;p=0.017). CONCLUSION. The prevalence of IVH in our setting was consistent with that of developed countries. Improving antenatal care, infection control, and adequate early resuscitation could decrease the incidence of IVH and cPVL. All VLBW infants should undergo cranial ultrasound screening. <![CDATA[<b>An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa</b>]]> OBJECTIVE. To determine the outcome of the endoscopic management of oesophageal strictures (OSs) of varying aetiology in children in a tertiary centre. METHODS. A retrospective chart review was conducted of all children aged <14 years at department of paediatric surgery who underwent endoscopic dilatation of OSs at Inkosi Albert Luthuli Central Hospital in Durban, KwaZulu-Natal Province, South Africa, between July 2002 to December 2010. Management status at 3 years after presentation was used to define outcome. RESULTS. A total of 39 patients aged between 1 month and 13 years were reviewed, and 18 (46%) were males. Thirty-six (92.3%) were black South Africans, and 11 (28%) were HIV-infected. Among the types of strictures, postoperative (35%) and corrosive (30.8%) OSs were more prevalent than HIV-related (20.5%) OSs. The mean number of dilatations needed per patient was 7.3, and those patients with corrosive OSs needed more dilatation sessions (median (interquartile range)) than others (10 (5 - 14) v. 6.5 (5 - 10)). Out of 287 attempted dilatations, oesophageal perforations occurred in 8 (2.8%) cases. Mitomycin C was applied topically in 4 (10.3%) patients, with excellent results. A good response to endoscopic treatment was seen in 27 (69%) cases. The worst outcome was noted in HIV-infected patients. CONCLUSION. Endoscopic treatment of OSs in children yields good results and has a low rate of treatable complications. Patients should be treated on an individual basis, even if they have strictures of the same aetiology. <![CDATA[<b>Risks associated with suspected dysphagia in infants admitted to a neonatal intensive care unit in a South African public hospital</b>]]> BACKGROUND. The prevalence of neonatal dysphagia is increasing, as medical advances contribute to the survival of critically ill and preterm infants. Additional factors such as low birth weight (LBW), gastro-oesoephageal reflux disorder, failure-to-thrive (FTT), and HIV may increase the complexity of dysphagia symptoms. Knowledge of context-specific risk factors for dysphagia may lead to an effective pathway of diagnosis and management in vulnerable neonates. OBJECTIVE. To describe the feeding characteristics and categories of underlying medical conditions in infants of gestational age 24 - 42 weeks. METHODS. The study was a retrospective review of 231 purposively selected medical and speech-language therapy records. Participants had a mean stay of 28.5 days in a neonatal intensive care unit in a peri-urban public hospital and were referred for a swallowing and feeding assessment. An existing seven-category framework for the classification of suspected dysphagia was used. RESULTS. Most participants (90.0%) presented with multiple medical conditions. Underlying neurological conditions (48.5%) and feeding difficulties secondary to systemic illness (65.8%) contributed mostly to suspected dysphagia in the sample. It was found that 71.0% of infants presented with feeding difficulties secondary to other conditions such as LBW and prematurity, highlighting the need for an expanded dysphagia classification framework. CONCLUSION. The results concur with the outcomes of previous studies and confirm the need for a unique classification framework in South Africa. Dysphagia is a complex condition and frequently cannot be attributed to a single risk factor. <![CDATA[<b>Nutritional adequacy of menus offered to children of 2 - 5 years in registered childcare facilities in Inanda, KwaZulu-Natal Province, South Africa</b>]]> BACKGROUND. The number of children that spend a large part of the day at childcare facilities (CCFs) has risen worldwide. The parent relies on caregivers in CCFs to provide children with balanced meals. Studies in various parts of South Africa (SA) that analysed CCF menus have found that the menus do not satisfy the daily requirements of energy and micronutrients for children. With increasing numbers of children attending CCFs, and an increase in the global prevalence of obesity, information with regards to food presented at the facilities was of interest not only to compare the energy, macro- and micronutrient intake, but also to consider the dietary diversity offered to the children on a daily basis. OBJECTIVES. To analyse menus offered to children in CCFs in Inanda, KwaZulu-Natal for nutritional adequacy and to calculate the contribution the meals make to the dietary reference intakes for children in the 2 - 5-year age category. METHODS. Permission from the Department of Social Development (DSD) in Durban was obtained to approach the CCFs to participate in the study. Ten CCFs in the Inanda area were randomly selected from the DSD list of 45 registered CCFs. The researcher gathered menus, recipes and serving sizes from each of the 10 CCFs. Food Finder version 3 software (MRC, SA), adjusted to include fortified wheat and bread products, was used to analyse the recipes. RESULTS. The CCFs in Inanda served breakfast and lunch to the children daily. The top 20 list of foods offered cereal-based staples of rice and maize meal more frequently than meat, dairy products and fruit and vegetables. None of the CCFs met 60% of daily requirements for energy, fibre and calcium for children in this age group. CONCLUSION. Menus offered to children aged 2 - 5 years in registered CCFs in Inanda are nutritionally inadequate. <![CDATA[<b>The impact of HIV infection and disease stage on the rate of weight gain and duration of refeeding and treatment in severely malnourished children in rural South African hospitals</b>]]> BACKGROUND. Evidence of the effects of HIV infection and clinical stage on the duration of refeeding and treatment (DRT) and the rate of weight gain (RWG) in severely malnourished children remains inconclusive. OBJECTIVES. To determine whether the RWG and DRT differ by baseline clinical characteristics, and to assess the effect of HIV status and disease stage on the relationship between these two clinical outcomes. METHODS. This was a retrospective record review of 346 patiens discharged between 2009 and 2013 following treatment for severe acute malnutrition (SAM) at two rural hospitals in South Africa. RESULTS. A third of the sample was HIV-positive, the RWG (measured as g/kg/day) was significantly slower in HIV-positive patients compared with HIV-negative cases (mean 5.2, 95% confidence interval (CI) 4.47 - 5.93 v. mean 8.51; CI 7.98 - 9.05; p<0.0001) and cases at stage IV of HIV infection had a significantly slower RWG (mean 3.97; CI 2.33 - 5.61) compared with those at stages I (mean 7.64; CI 6.21 - 9.07) (p<0.0001) and II (mean 5.87; CI 4.74 - 6.99). The mean DRT was longer in HIV-positive cases and those at advanced stages of HIV infection. HIV-positive cases were renourished and treated for almost 3.5 times longer than their HIV-negative counterparts to achieve a moderate RWG (5 - 10 g/kg/day). CONCLUSION. This study highlights the need to reconsider energy requirements for HIV-positive cases at different clinical stages, for more rapid nutritional recovery in under-resourced settings where prolonged hospitalisation may be a challenge. <![CDATA[<b>Screening for retinitis in children with probable systemic cytomegalovirus infection at Tygerberg Hospital, Cape Town, South Africa</b>]]> BACKGROUND. The incidence of immunocompromised children with probable systemic cytomegalovirus (CMV) infection is increasing. Currently, there is no protocol for screening children for CMV retinitis in South Africa. Screening for CMV retinitis may prevent permanent visual impairment. OBJECTIVES. To determine the prevalence of retinitis in children with probable systemic CMV infection. To assess the value of clinical and laboratory data in identifying risk factors for the development of CMV retinitis in children. METHODS. A retrospective, cross-sectional study design was used. All children (< 2 years) with probable systemic CMV infection who underwent ophthalmic screening over a 5-year period, were included. Presumed CMV retinitis was diagnosed by dilated fundoscopy. All cases were evaluated to identify possible risk factors for the development of CMV retinitis. RESULTS. A total of 164 children were screened. Presumed CMV retinitis was diagnosed in 4.9% of participants. Causes of immunosuppression were HIV infection (n=7) and chemotherapy (n=1). HIV infection showed a definite trend towards association with the development of CMV retinitis in our study population (p=0.064). CONDUSION.The prevalence of CMV retinitis was 4.9% in our sample. Other than HIV, we were not able to identify additional risk factors for CMV retinitis. Our results show that CD4 levels are possibly not a reliable indicator to predict CMV retinitis. <![CDATA[<b>Presentation and pattern of childhood renal diseases in Gusau, North-Western Nigeria</b>]]> BACKGROUND. Studies from different parts of Nigeria and the world have reported variable patterns of renal diseases in childhood. There is a paucity of data to guide resource allocation in Zamfara, Nigeria, despite the rising incidence of kidney diseases in children in Nigeria, and globally. OBJECTIVES. To determine the prevalence, presentation, pattern, and outcomes of renal diseases among hospitalised children in Gusau, Zamfara State, Nigeria. METHODS. A retrospective study was conducted of children aged 1 month to 14 years, who were admitted to the paediatric wards of our hospital over a period of 30 months (October 2013 to March 2016). Relevant information was retrieved from the patients' medical records and data were analysed accordingly. RESULTS. A total of 2 658 children were admitted, of which 3.2% (n=84) had renal diseases; however, only 70 folders were utilised for the study. The male:female ratio was 1.19:1. Fever (63%), reduction in urine volume/frequency (46%), body swelling (43%) and abdominal pain (40%) were the most common symptoms. Hypertension (33%) and heart failure (17%) were common findings. Urinary tract infection (UTI) (34%), acute glomerulonephritis (AGN) (24%) and acute kidney injury (AKI) (20%) were the the most common diagnoses. Most of the children were discharged with good renal function and mortality was low (10%). CONCLUSIONS. The prevalence of renal disease in our setting was low, with males predominating. UTI was the most common cause of renal disease, requiring hospitalisation in Gusau, while congenital anomalies and malignancies were rare. These data could be utilised by researchers and stakeholders in resource-poor settings like ours to plan for preventive nephrology as UTI, AGN and AKI are largely preventable. <![CDATA[<b>Neonatal sepsis: Highlighting the principles of diagnosis and management</b>]]> Neonatal sepsis is a clinical syndrome consisting of nonspecific symptoms and signs of infection, accompanied by a bacteraemia in the first 28 days of life. The risk of neonatal sepsis and death increases with decreasing birth weight and gestational age. South African data have reported the overall incidence of neonatal sepsis to be 8.5 - 10%, with late-onset sepsis accounting for most of these infections. The diagnosis of neonatal sepsis is not always straightforward, and the initiation and continuation of antimicrobials in these situations relies on good clinical judgment. The need for empirical antimicrobials is driven by the existence of risk factors for early-onset sepsis and clinical symptoms and signs of late-onset sepsis. Antimicrobial stewardship programmes should be in place to guide clinicians to either stop, change, or continue antimicrobials. Institution-specific knowledge of the most common pathogens and the antimicrobial susceptibility pattern is important to prevent the emergence of further antimicrobial resistance. <![CDATA[<b>Chediak-Higashi syndrome presenting in the accelerated phase</b>]]> Chediak-Higashi syndrome (CHS) is an extremely rare autosomal recessive disorder characterised by recurrent pyogenic infections, partial oculocutaneous albinism, and mild bleeding. The most reliable finding that helps in diagnosis is abnormally large granules in leukocytes and other granule-containing cells. Herein we report a case of CHS in a 3-month-old girl who presented to us in the accelerated phase of the disease. The case is reported because of the extreme rarity of CHS presenting in the accelerated phase at diagnosis.