Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 7 num. 2 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Adverse individual outcomes of healthcare</b>]]> <![CDATA[<b>Paediatric triage in South Africa</b>]]> Reducing child mortality is a high priority in sub-Saharan Africa, and swift, appropriate triage can make an important contribution to this goal. There has been a lot of interest and work in the field of triage of sick children in South Africa over the past few years. Despite this, in many parts of South Africa no formal system for triage of children in acute and emergency settings is used. This article aims to explain some of the key paediatric triage tools being considered and developed in South Africa. The triage tools discussed are the World Health Organization Emergency Triage Assessment and Treatment (ETAT), the South African adaptation of this tool known as ETAT-SA, the South African Triage Scale (SATS), and the Revised Paediatric SATS (P-SATS). The article describes how they were developed and their relevance to the country. <![CDATA[<b>Characteristics of children presenting with newly diagnosed type 1 diabetes</b>]]> BACKGROUND: The clinical presentation of type 1 diabetes in children can be acute or insidious, and symptoms may be subtle and frequently misinterpreted. Presentation with diabetic keto-acidosis (DKA) may be associated with significant morbidity and mortality in the paediatric population. This study aims to determine the characteristics of children presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central Hospital (IALCH) with DKA at the time of diagnosis, and to determine the frequency of missed diagnoses in the previous month. METHODS: A retrospective study was done at IALCH, the paediatric tertiary referral centre for KwaZulu-Natal, South Africa. The study sample included all children with an initial diagnosis of type 1 diabetes between January 2008 and June 2010. Children presenting with DKA were compared with those who presented without DKA. RESULTS: During the period under review, 63 children presented with type 1 diabetes. Of these, 44 (69.8%) had DKA at the time of diagnosis. The median duration of symptoms preceding diagnosis in the DKA group was 2 weeks, versus 4 weeks in the non-DKA group (p=0.002). There was no significant difference between the groups when ethnicity, gender and age at presentation were compared. Of 42 patients who presented to healthcare facilities in the month preceding diagnosis, 27 (64.3%) were misdiagnosed. CONCLUSION: Patients who presented with DKA had a shorter duration of symptoms than the non-DKA group. Ethnicity had no effect on characteristics at presentation. There was an unacceptable rate of missed diagnoses of type 1 diabetes in both the private and public sectors. <![CDATA[<b>Normal anterior fontanelle sizes in newborn Igbo babies in south-eastern Nigeria</b>]]> BACKGROUND: Several factors, including gestational age (GA), gender, race and geographical/regional area, contribute to variations in the size of the anterior fontanelle (AF). While the impact of GA and gender are clearly established, the influences of region and ethnicity vary in the published literature. OBJECTIVES: To assess AF sizes in normal newborn Igbo babies in south-eastern Nigeria, establish baseline values for our population, and evaluate the relationship of our findings to some factors reported to affect AF size. METHODS: AF size was measured in 269 healthy term newborn babies using the method proposed by Popich and Smith and modified by Faix. Measurements were taken 24 - 48 hours after birth. RESULTS: The mean AF size was 2.97 cm (± standard deviation (SD) 0.71, range 2.0 - 4.8). Female babies had slightly larger anterior fontanelles than males (2.98±0.75 cm v. 2.97±0.67 cm, respectively), although this was not statistically significant (p&gt;0.05). Size of the AF had no significant correlation with head circumference (Pearson correlation coefficient r=-0.01; p=0.89), birth weight (r=-0.05; p=0.39) or length (r=-0.00; p=0.99) of these term babies. Neither GA nor mode of delivery influenced AF size (p&gt;0.05). The mean anteroposterior dimension of the AF (3.22±0.82 cm) was significantly longer than the mean transverse dimension (2.71±0.65 cm) (p<0.01). CONCLUSIONS: At term, AF size has no relationship to GA or such growth parameters as head circumference, birth weight and length. The mean AF size of 2.97±0.71 cm obtained in this study is recommended for use in assessing term Igbo newborns. <![CDATA[<b>A study to evaluate the performance of black South African urban infants on the Bayley Scales of Infant Development III</b>]]> BACKGROUND: A suitable tool is needed to assess child development in South Africa (SA). Using Western normed tools presents difficulties. AIM: To determine whether the Bayley Scales of Infant Development III (Bayley-III) can be used on black African urban infants in SA. METHOD: One hundred and twenty-two black African infants in Gauteng, SA, were assessed using the Bayley-III. RESULTS: Overall the SA mean score was 103.4, which is statistically significantly higher (p=0.0007) than the mean of 100 for the USA. For subtests, the mean score was 99.7 for the cognitive, 106.8 for the language and 103.5 for the motor subtests as opposed to 100 for the USA. CONCLUSION: The results of this study showed that SA scores were statistically significantly higher than the US norms. Clinically, however, the difference is small when one considers the variability of development. RECOMMENDATION: The Bayley-III is a suitable tool for use on the black urban African population in Gauteng, SA. <![CDATA[<b>An audit of paediatric intussusception radiological reduction at the Bloemfontein Academic Hospital Complex, Free State, South Africa</b>]]> BACKGROUND: Intussusception remains the most common cause of bowel obstruction in infants and toddlers and can result in considerable morbidity and mortality if not properly treated. The aim of this study was to determine the success rate of air intussesception reduction (AIR), and to identify factors predicting an unsuccessful procedure, among paediatric patients diagnosed with idiopathic intussusception at the Bloemfontein Academic Hospital Complex, Free State, South Africa. METHODS: This retrospective analytic cohort study assessed data from the records of all paediatric patients with the diagnosis of idiopathic intussusception discharged from the Department of Paediatric Surgery between 1 January 2003 and 30 September 2011. RESULTS: Thirty-five children with intussusception were identified. AIR enemas were performed in 18 children (51.4%), with successful reduction in 2 (11.1%). Seventeen children (48.6%) were primarily treated surgically without attempting radiological reduction. Successful AIR was more likely if the duration of symptoms was <48 hours. Sixteen patients in whom AIR was attempted eventually required surgical intervention, either due to perforation during AIR or irreducibility. Approximately 94% of children required bowel resection at surgery. In 37.5% of cases AIR was complicated by perforation, making surgical treatment mandatory. Nine patients (56.3%) had unsuccessful AIR without perforation, but needed bowel resection at surgery. One patient (6.3 %) required manual reduction only, without the need for bowel resection at surgery. No deaths were recorded during the period covered by this audit. CONCLUSIONS: Our institution's radiological reduction outcomes were not comparable to international standards. The only statistically significant predictor of poor outcome of AIR was time delay before attempted reduction. <![CDATA[<b>Langerhans cell histiocytosis</b>: <b>A case presentation and literature review</b>]]> Langerhans cell histiocytosis (LCH) is a disease of unknown aetiology. It is characterised by extreme clinical heterogeneity that can bring it to the attention of a variety of healthcare workers. A high index of suspicion is key to early diagnosis. Once the diagnosis has been confirmed, all cases should be referred to a paediatric oncologist for risk stratification and further management. We present a case of a toddler with LCH with skeletal involvement, who primarily presented to an orthopaedic surgeon. Relevant knowledge about this condition is reviewed. <![CDATA[<b>Mythological ears, a real deformity</b>: <b>A case of bilateral Stahl's ears in a South African girl</b>]]> Stahl's ear is a rare congenital deformity of the pinna with a third crus resulting in an 'elf-like', 'Vulcan-like' or 'satyr-like' appearance with pointing of the ears. Early recognition of the condition allows successful early conservative treatment and may avoid the need for surgical correction at a later stage. We present the case of a 7-year-old South African girl with bilateral Stahl's ears, who presented with psychological distress as a result of being ridiculed at her school. The deformity was surgically corrected with a good cosmetic result and patient satisfaction. <![CDATA[<b>Compound heterozygous sickle cell disease and</b> β<b><sup>0</sup></b><b>-thalassaemia</b>: <b>An interesting case</b>]]> Haemoglobinopathies are a group of inherited disorders caused by structural variations of the haemoglobin molecule. We report the case of a 5-year-old girl suffering from chronic haemolytic anaemia. A diagnosis of compound heterozygous sickle cell disease (SCD) and β0-thalassaemia was established using haemoglobin sub-fractionation studies and parental screening. The latter revealed the father and mother to have heterozygous SCD and heterozygous β-thalassaemia, respectively. Evaluation of children with a haemolytic anaemia requires a thorough history and physical examination, appropriate laboratory testing and careful interpretation of the results. <![CDATA[<b>Fetal valproate syndrome in a 14-month-old child</b>: <b>A case report</b>]]> Anti-epileptic drugs administered during pregnancy can cause structural defects in the growing fetus and result in adverse neuro-developmental outcome later in life. Fetal valproate syndrome (FVS) results from teratogenic effects of valproic acid exposure in the prenatal period. It is characterised by a distinctive dysmorphic facies and a cluster of minor and major anomalies, as well as developmental and behavioural abnormalities. We describe a 14-month-old boy with the typical dysmorphic facies and other congenital abnormalities characteristic of FVS. There was a history of maternal intake of sodium valproate during pregnancy. The mechanism of teratogenicity and methods for prevention are discussed. <![CDATA[<b>Tubercular cold abscess at an unusual site mimicking a pyogenic abscess</b>]]> Tuberculosis affects much of the world's population, and 1 - 5% of all cases are musculoskeletal. Tuberculosis of the soft tissues secondary to underlying bone involvement is not uncommon, but selective tissue involvement without bony abnormality is rare. We present a case in which two tubercular abscesses presented at an unusual site with no underlying bony involvement, simulating a pyogenic abscess. <![CDATA[<b>Abdominal Burkitt's lymphoma with renal involvement</b>]]> Endemic Burkitt's lymphoma is the most frequent childhood cancer in Africa, commonly presenting with involvement of the abdominal viscera. Imaging plays a critical role in suggesting the diagnosis to expedite treatment initiation, as the tumour has a rapid doubling time of less than 24 hours. This case report illustrates the classic nodal and infrequent renal appearance on computed tomography scans.