Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 8 num. 4 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>A new broom?</b>]]> <![CDATA[<b>Hospital-acquired <i>Klebsiella pneumoniae</i> infections in a paediatric intensive care unit</b>]]> BACKGROUND: Hospital-acquired infections (HAI) are a significant problem in the delivery of intensive care services. Each nosocomial infection prolongs an affected patient's stay in hospital by 5 - 10 days. METHODS: A retrospective case control chart review of children admitted to the paediatric intensive care unit (PICU) in Grey's Hospital between July 2003 and December 2010, who developed a hospital-acquired Klebsiella pneumoniae infection, was undertaken to describe the trend in HAI in a newly commissioned PICU and to identify any association with the patient demographics and modalities of care. Patients with a K. pneumoniae infection were identified through the PICU infection control surveillance system. Each case was matched to a control of the same age admitted during the same period, with a similar clinical diagnosis. RESULTS: During the 7.5-year period, 2 266 children <12 years of age were admitted to the PICU. Of these, 113 had K. pneumoniae cultured from a body fluid &gt;48 h after admission, including 23 cultured from the blood. Clinical records were obtained for 14 of these patients and matched to control cases of similar age and gender who were admitted at the same time. The length of stay in both the PICU and hospital was longer in children with an HAI compared with the control group (3.7 v. 2.9 and 18.5 v. 9.14, respectively; p=0.04). There was no significant difference in the treatment modalities provided to the two groups, although most patients in the sample group required invasive treatment. CONCLUSION: K. pneumoniae nosocomial infection was a significant problem encountered in Grey's Hospital paediatric intensive care. It has major cost implications, as it prolongs the length of stay in intensive care and hospital. <![CDATA[<b>The cost of nephroblastoma treatment in South Africa: A very cost-effective investment with guidelines for the rest of Africa</b>]]> BACKGROUND: Nephroblastoma is one of the most common childhood malignancies in Africa, but with a survival rate significantly lower than in developed countries. In African countries with a small gross domestic product (GDP) per capita, the cost of treating nephroblastoma may be prohibitive. OBJECTIVES: To determine the direct costs of treatment of nephroblastoma in South Africa (SA) and to propose a more cost-effective approach to investigations and treatment for the disease in Africa. METHODS: Data from 2000 to 2010 from two SA paediatric oncology units were retrospectively analysed. The costs included investigations, chemotherapy and radiotherapy, comparing early- v. advanced-stage disease. In both units, the nephroblastoma International Society of Paediatric Oncology (SIOP) protocol was used. RESULTS: Stage I disease was the most common, followed by stage IV. The total cost of diagnosis, staging and treatment of stage I disease was ZAR9 304.97 (EUR882.80 or USD1 093.40), compared with a five-times higher cost for stage IV (ZAR48 293.62 (EUR4 581.9 or USD5 674.9)). Treating one patient averted more than 32 disability-adjusted life years. The investigation and treatment of early- and advanced-stage disease is very cost-effective when compared with the local GDP per capita. CONCLUSION: The cost of investigation and treatment of nephroblastoma remains a challenge everywhere, but especially in Africa. However, it is a very cost-effective disease to treat and children in Africa should not be denied treatment. <![CDATA[<b>Characteristics and mortality rate of neonates with congenital cytomegalovirus infection</b>]]> BACKGROUND: Cytomegalovirus (CMV) infection is a common congenital infection in neonates. Clinical presentation and laboratory findings in CMV-infected infants in a setting where HIV is prevalent are not well characterised. OBJECTIVE: To determine the characteristics and survival to hospital discharge of neonates with congenital CMV infection. METHODS: In this retrospective, case-control study, hospital records of neonates, tested for CMV in the first 3 weeks of life from January 2004 to December 2008, were reviewed for maternal and neonatal characteristics, clinical presentation, laboratory findings and inpatient mortality. Comparisons were made between CMV-infected and CMV-uninfected neonates in those infants who were tested for CMV. RESULTS: Among the CMV-infected, 91% were of low birth weight, 83% were preterm and 29% were small for gestational age. The CMV-infected neonates were more likely to present with hepato/splenomegaly compared with uninfected neonates (p=0.02). Thrombocytopenia was more severe in CMV-infected neonates (p=0.004). Congenital CMV-infected neonates were more likely to be HIV-exposed (p=0.003) and HIV-infected (p=0.02). Mortality before hospital discharge was significantly higher in congenital CMV-infected neonates (p=0.01) and in those with HIV co-infection (p=0.02). The male gender was a significant independent predictor of inpatient mortality (odds ratio: 23, 95% confidence interval 1.19 - 445.698; p=0.04). CONCLUSION: Neonates presenting with hepato/splenomegaly and severe thrombocytopenia are most likely to be CMV-infected. Neonates with congenital CMV are more likely to be co-infected with HIV. The co-infection of CMV and HIV is associated with a high mortality rate, especially in male neonates. <![CDATA[<b>Maternal sociodemographic factors that influence full child immunisation uptake in Nigeria</b>]]> BACKGROUND: With vaccine-preventable disease accounting for many <5-year deaths in most developing countries, it is imperative to determine the factors responsible for poor immunisation coverage in these countries. OBJECTIVE: To identify maternal sociodemographic factors associated with child immunisation uptake in Nigeria. METHODS: Data from a nationally representative sample of mothers (aged 15 - 49 years) were obtained from the 2008 Nigeria demographic and health survey. Logistic regressions were used to examine the association between maternal sociodemographic variables and child immunisation uptake. RESULTS: The overall uptake of full immunisation based on the National Programme on Immunisation schedule was 30.6%. There was wide variation in full immunisation uptake in the different regions in Nigeria, with 51% in the South-West, 46.5% in the South-East, 39.5% in the South-South, 6.4% in the North-West, 11.8% in the North-East and 28.2% in the North-Central. Approximately 40.2% of children surveyed had never received any form of vaccination. The most common reasons given for non-vaccination of these children were lack of information about immunisation, fear of side-effects and the immunisation centres being too far away. It was noted that uptake of vaccines with multiple dosing schedules dropped with each successive dose. Decreased likelihood for full immunisation was seen in mothers <18 years old (odds ratio (OR) 0.53; confidence interval (CI) 0.34 - 0.84) and mothers residing in the northern regions. Increased likelihood for full immunisation was seen in mothers from middle and rich classes (OR 1.26, CI 1.03 - 1.66 and OR 1.69, CI 1.27 - 2.25, respectively), mothers with higher educational level (OR 3.77, CI 1.52 - 9.32), mothers with access to media (OR 1.84, CI 1.21 - 1.68), mothers resident in urban areas (OR 1.36, CI 1.22 - 1.51) and mothers who had institutional deliveries (OR 1.86, CI 1.44 - 2.40). CONCLUSION: Full immunisation uptake in Nigeria is poor. Cultural disparity in different regions of Nigeria may account for the wide variation in immunisation coverage observed. <![CDATA[<b>Current practice of air medical services in inter-facility transfers of paediatric patients in the Western Cape Province, South Africa</b>]]> OBJECTIVE: To describe the utilisation and safety of air medical services (AMS), when being used for inter-facility transfers of paediatric patients in the Western Cape Province, South Africa. METHODS: A retrospective descriptive analysis was conducted for the time period January 2010 to December 2011. Data were recorded from the Cape Town base of the AMS provider for the Western Cape Provincial Department of Health Emergency Medical Services. Patient demographics, flight and transfer details, interventions performed and adverse events encountered were documented for all patients <13 years of age transferred by either helicopter or fixed-wing aircraft. RESULTS: A total of 485 patients was analysed. More patients were transported by helicopter (n=263, 54%), with neonates making up the largest category for both modes of transfer. Respiratory (29%), neurological (18%), cardiac (14%) and gastrointestinal disorders (14%) made up the majority of non-traumatic reasons for transfer. Overall, transfers by helicopter were quicker (median mission time 03:00; interquartile range 02:32 - 03:25) compared with fixed-wing transfer (05:24; 04:22 - 06:20). The overall incidence of adverse technical events was relatively high (20%). Physiological adverse events ranged between 2% and 16% overall depending on the variable measured. The incidence of cardiac/respiratory arrest and endotracheal tube obstruction/dislocation was low (<2%). Emergency intubation and desaturation &gt;10% from baseline were the most common critical adverse events encountered (6%). CONCLUSION: Current utilisation of the AMS for paediatric inter-facility transfer is relatively high, at ~25%. Across both the helicopter and fixed-wing platforms, patients with a diverse range of pathologies of equally varying severities were transferred. The adverse events observed were found to be lower than those of trials examining non-specialised paediatric transfer, and were comparable to those seen with transfer by specialised paediatric retrieval teams. The AMS remain a safe and viable alternative to non-specialised paediatric transfer, and may serve as a potential alternative to specialised paediatric transfer in the Western Cape. <![CDATA[<b>Birth weight recovery among very low birth weight infants surviving to discharge from Charlotte Maxeke Johannesburg Academic Hospital</b>]]> BACKGROUND: The recommended growth velocity (GV) of very low birth weight (VLBW) infants is 15 g/kg/day. Several factors have been associated with poor postnatal weight gain. OBJECTIVE: To provide current information on the postnatal growth of VLBW infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). METHODS: This was a longitudinal study of VLBW infants surviving to discharge from CMJAH neonatal unit from August to October 2013. RESULTS: Sixty-nine infants were included in the study. The mean GV was 13.2 g/kg/day, the median weight loss was 7.69% and the median time for regaining birth weight was 16 days. Fifty-one infants (73.9%) regained their birth weight at or before 21 days. There was a decrease in mean z-scores for weight (ZSWs) from -0.32 (standard deviation 1.25) at birth to -1.94 (1.35) at discharge. A multiple linear regression showed a negative association between ZSW at discharge and number of days nil per os without parenteral nutrition (PN). Antenatal steroids were associated with poor GV. There were no factors associated with regaining birth weight after 21 days on multiple logistic regression. CONCLUSION: This study showed a GV in VLBW infants approaching recommended standards. Number of days without PN and use of antenatal steroids were associated with poor postnatal growth. <![CDATA[<b>Dominant preference and school readiness among grade 1 learners in Bloemfontein</b>]]> BACKGROUND: There is a paucity of published research with regard to dominant preference and school readiness in preschool children, and what is available has become somewhat outdated. OBJECTIVES: To determine the dominant preference among grade 1 learners in Bloemfontein, and to determine whether the establishment of a dominant profile had an influence on school readiness of grade 1 learners in Bloemfontein. An additional purpose was to determine whether there was a statistically significant difference in obtaining school readiness between children with a mixed dominant preference profile and those with a pure dominant profile. METHODS: The Aptitude Test for School Beginners, which measures school readiness, and performance tests to determine the child's dominant eye, ear, hand and foot, were conducted on each of the 353 grade 1 learners who participated in the study. There were 161 boys and 192 girls from five different primary schools in Bloemfontein involved in this study. RESULTS: The results found that 62% of the children preferred their right eye, 68% preferred their right ear, 92% preferred their right hand and 90% preferred their right foot. A total of 54% of the children exhibited a mixed lateral preference, while only 46% exhibited a pure lateral preference of which only 4.2% had pure left dominance. Insignificant differences were found between the dominant profiles of boys and girls. CONCLUSION: Most of the participants were right-side dominant; gender did not influence dominant preference and dominant preference had no significant influence on school readiness. <![CDATA[<b>Neonatal cleft lip repair in babies with breastfeeding difficulties at Polokwane Mankweng Hospital Complex</b>]]> BACKGROUND: A cleft lip (CL) is a congenital abnormality resulting from failure of union of the medial and nasal prominences with the maxillary prominence during embryonic development. CL may be classified as incomplete, complete, unilateral, bilateral or median. It may be associated with a cleft alveolus or a cleft palate. Definitive correction of a cleft lip is by surgery. In most African settings, the birth of a cleft lip and cleft palate (CLP) baby is associated with witchcraft and ancestral spirits. The parents, particularly mothers, are stigmatised. OBJECTIVE: To repair CLs in neonates with difficulties in breastfeeding. METHODS: Non-syndromic term neonates referred to Polokwane Mankweng Hospital Complex (PMHC) from primary and secondary hospitals with CLP and difficulties in breastfeeding were prospectively admitted to the neonatal unit. Our breastfeeding team supervised and assisted them with breastfeeding. The neonates whose breastfeeding was found to be unsatisfactory were considered for neonatal CL repair. Those who breastfed adequately were booked for later lip repair as per the rule of tens and discharged. RESULTS: From June 2009 to March 2012, 60 children with CLP were referred to PMHC, including 36 neonates. Of these, 23 neonates were unable to breastfeed satisfactorily and were operated at a median age of 9 (range 3 - 28) days. The median weight was 2.8 (1.8 - 3.7) kg. The median haemoglobin was 13.1 (11.5 - 16) g/dL. CONCLUSION: Neonatal CL repair is an alternative for those with breastfeeding difficulties. Eagerness to breastfeed increased following the lip repair with subsequent improvement in maternal confidence and interaction with the baby. At follow up, weight gain was above the 50th centile on the road to health charts. Early surgery prevents exposure of CL to the public with highly positive possible outcome of decreasing the potential for stigmatisation. <![CDATA[<b>Atypical teratoid/rhabdoid tumour in a supratentorial location: A report of two cases</b>]]> Atypical teratoid/rhabdoid tumour of the central nervous system is a rare, highly aggressive childhood malignancy. The age of presentation is usually <2 years, but this tumour may occur in other age groups. The typical location is the posterior fossa, with supratentorial origin less common. We present two cases of atypical teratoid/rhabdoid tumours, with the suprasellar location of one case proving to be a diagnostic radiological challenge.