Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 12 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Hypernatraemic dehydration: Do we have consensus on its treatment?</b>]]> <![CDATA[<b>Pattern and predictors of psychosocial disorders among overweight and obese children in Enugu, Southeast Nigeria</b>]]> BACKGROUND. Obesity in children is recognised as a public health problem worldwide. This is due to the high prevalence rate, as well as the associated adverse health and psychosocial effects. Psychosocial disorders negatively impact on children. OBJECTIVES. This study aims to determine the pattern and predictors of psychosocial disorders among overweight and obese children in Enugu, Nigeria. METHODS. A descriptive cross-sectional study among adolescents attending secondary schools in Enugu was conducted. Sampling followed stratified and multi-staged methods. Participants' weight and height were measured and their body mass index (BMI) determined. Questionnaires were also used and the information obtained included psychometric measurements. Data was analysed using SPSS version 19. χ² and logistic regressions were carried out where a p-value <0.05 was considered significant. RESULTS. The mean age (standard deviation (SD)) of the 200 students included in the study was 12.9 (1.8) years. Most of the subjects suffered from depression (46%) and there was a significant association between anxiety and obesity in females (p=0.03), who were ~3 times more likely to be anxious than boys (OR 2.6; 95% confidence interval (CI) 0.78 - 8.36). Low self-esteem was also found to be closely associated with obese girls (p=0.002), who were about 3 times more likely to have a low self-esteem compared with males (OR 2.7; 95% CI 0.95 - 7.55). Obesity was stigmatised (p=0.002) and obese students were almost 5 times more likely to feel stigmatised than overweight students (OR 5.01; 95% CI 1.80 - 13.9). CONCLUSION. Obesity was directly associated with stigma and, while female gender predicts anxiety and low self-esteem, obesity itself was a predictor of stigmatisation among obese children. <![CDATA[<b>Hypernatraemic dehydration in infants with acute gastroenteritis at King Edward VIII Hospital, Durban, South Africa</b>]]> BACKGROUND. Acute gastroenteritis (AGE) is a leading cause of infant mortality, with hypernatraemic dehydration contributing to increased morbidity and mortality. OBJECTIVES. To determine the prevalence of hypernatraemia secondary to AGE in admitted infants in Durban, South Africa. To describe the feeding choices, nutritional status and outcomes of these patients. To determine the association between admission sodium (Na) level, the rate of Na correction and clinical outcomes METHODS. A retrospective chart review was conducted on cases ofhypernatraemic dehydration admitted in 2014 to a South African hospital. Serum Na levels were corroborated with National Health Laboratory Services results. Descriptive and analytical statistics were done using Statistical Package for Social Sciences version 22. RESULTS. A 12.3% prevalence ofhypernatraemia (n=41/334) was found. The majority of infants were formula-fed (76%) with a 21% incidence of malnutrition and 66% HIV exposure rate in this cohort. A high rate of neurological abnormalities (63%), and a 4.9% case fatality rate was found. Shock on admission was present in 92% of patients who developed severe neurological complications. The mean admission Na was higher in those with severe neurological complications (164.2 v. 158.4 mmol/L, p=0.08). The mean rate of Na change was not faster in those with severe neurological morbidity (0.61 v. 0.91 mmol/L/hr; p=0.1). CONCLUSION. Hypernatraemic dehydration remains a significant problem in South Africa. High rates of formula feeding may be a contributory factor and the correlation with HIV infection needs investigation. Poor neurological outcomes were noted particularly in those patients presenting with hypernatraemia and shock. Although the mean admission Na level was higher in patients with severe neurological complications, this was not statistically significant in this sample. This study supports the hypotheses that neurological complications in diarrhoea-related hypernatraemia are largely associated with the severity of the dehydration that occurs prior to presentation rather than following rehydration. <![CDATA[<b>The profile of meningitis in a tertiary paediatric hospital in South Africa</b>]]> BACKGROUND. Meningitis in children is a major health problem worldwide, leading to high rates of mortality and morbidity. OBJECTIVES. To describe the profile of patients treated for meningitis at a leading tertiary paediatric hospital (Red Cross War Memorial Children's Hospital) in South Africa. METHODS. This study describes all patients treated for suspected meningitis at our hospital from 2010 to 2012. Data were retrospectively collected from patient folders. RESULTS. A total of 706 patients with meningitis were divided into definite bacterial (n=42), probable bacterial (n=113), partially treated bacterial (n=100), viral (n=412), and tuberculous meningitis (TBM, n=39)) infections. Fever (74.7%), headache (66.4%), vomiting (52.1%) and irritability (34.5%) were common symptoms in all patients; TBM patients presented more often with weight loss, neck stiffness, lethargy and abnormal neurological signs. Symptoms were usually present for 1 - 2 days in viral and bacterial meningitis, and 8 days in TBM. The median duration of hospitalisation was 1 day for viral meningitis, 2 days for all three groups of bacterial meningitis and 22 days for TBM, before referral to primary or secondary hospitals. CONCLUSION. Patients with meningitis in this study often presented with nonspecific symptoms, making it difficult to clinically differentiate between types of meningitis. TBM patients presented more often with neurological fallout, and had a longer duration of symptoms. Patients often received antibiotics before a lumbar puncture was performed, further compounding the difficulty of diagnosis. Swift, sensitive and specific novel diagnostic tools would aid clinicians in making timeous and accurate diagnoses and treatment decisions. <![CDATA[<b>Paediatric splenectomy: The Johannesburg experience</b>]]> BACKGROUND. Splenectomy is an uncommon procedure in children, and data on children who underwent splenectomy in South Africa are sparse. OBJECTIVE. To describe the profile, operative management and outcomes of children undergoing splenectomy. METHODS. The records for all children aged 0 to 16 years who underwent splenectomy at Charlotte Maxeke Johannesburg Academic (CMJAH) and Chris Hani Baragwanath Academic (CHBAH) hospitals between 2000 and 2015 were reviewed. Student's t-tests and χ² tests were used to analyse the data. RESULTS. The mean age at surgery was 9.9 years (range 3-16). Most splenectomies (91%; n=30/33) were performed for haematological disorders and were open (67%; n=22/33). The mean post-operative length of stay (LOS) was shorter in the laparoscopic (4.5 days) than the open (7.1 days) groups (p<0.05). Surgical complications were more common in the laparoscopic (36%, 4/11) than open (9%; n=2/22) group, and in children older than the mean age at time of surgery. No cases of overwhelming post splenectomy infection (OPSI) were noted. At study completion, 61% (n=20/33) of patients were alive, 9% (n=3/33) had demised, and 30% (n=10/33) were lost to follow-up. CONCLUSION. Local indications for paediatric splenectomy mirror those found in international literature. Mean and median postoperative lengths of stay (LOS) were shorter in the laparoscopic than open group, but relatively longer for both groups than reported internationally. Laparoscopy is not currently the preferred technique for splenectomy in our setting. All mortalities were due to progression of underlying disease and no cases of OPSI were recorded. The high loss-to-follow-up rate in this study is a significant barrier to accurate data collection, analysis and reporting. <![CDATA[<b>Neonatal mortality at Leratong Hospital</b>]]> BACKGROUND. There has been a high demand for delivery services at Leratong Hospital; however, no study on the causes of neonatal mortality has been conducted. It was therefore essential to identify the causes of newborn deaths so as to implement policies that would advance neonatal care. OBJECTIVES. To determine the neonatal mortality rate (NMR), the primary causes of neonatal death and the occurrence of avoidable health factors. METHODS. This prospective descriptive study was conducted at the neonatal unit of Leratong Hospital, Johannesburg, South Africa. Clinical records of all neonates who were admitted between April 2013 and July 2013 were reviewed. RESULTS. A total of380 neonates were admitted to Leratong Hospital over the 4-month period and 46 newborns died. The mean age (standard deviation (SD)) of all neonates admitted was 5 (5.8) days. Their mean (SD) weight was 1824.5 (29) g. Almost 37% of neonates died within 24 hours of admission. The 3 most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than 60% of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low-birth-weight neonates. Staff shortage was found to be a contributor in 63% of deaths. Thirty-seven per cent of neonates could not be ventilated due to a shortage of ICU beds. The significant predictors relating to neonatal death were: preterm birth (OR 3.1, 95% CI 1.7 - 6.0), extremely low birth weight (OR 27.5; 95% CI 8.2 - 92.6), very low birth weight (OR 5.0; 95% CI 2.1 - 12.3) and birth by caesarean section (OR 3.2; 95% CI 1.6 - 6.2). CONCLUSION. The neonatal mortality rate at Leratong Hospital was lower than the rates found in other studies. Preterm birth, low birth weight and birth by caesarean section were the strongest predictors of death. These deaths could have been avoided through provision of high-care services and an adequate number of nurses who were trained in both newborn care and early detection of perinatal asphyxia. <![CDATA[<b>Retrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg Academic Hospital</b>]]> BACKGROUND. Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome characterised by high pulmonary pressures, low systemic pressures and severe hypoxaemia due to circulation transition failure after birth. OBJECTIVE. To determine the incidence of and describe the risk factors, infant characteristics and treatment strategies for PPHN at Charlotte Maxeke Johannesburg Academic Hospital over the last 8 years. METHODS. This was a retrospective descriptive study. Patient records of neonates who had a discharge diagnosis of PPHN were reviewed for the period from January 2006 to December 2013. Neonates' PPHN diagnosis was based on clinical criteria and, where possible, echocardiography. Neonates with a congenital cyanotic heart defect were excluded. RESULTS. A total of 81 neonates had a discharge diagnosis of PPHN, of whom 72 were included in the study. Of the 72 neonates, 37 (51.4%) were female, 38 (52.8%) were born by vaginal delivery and 44 (61.1%) were inborn. The mean (standard deviation (SD)) birth weight was 2.94 (0.69) kg while the mean (SD) gestational age was 38.2 (3.3) weeks. Meconium aspiration syndrome (MAS) was seen in 43 neonates (59.7%) and was the most common disease underlying PPHN. Of the 72 neonates, 67 (93.1%) required mechanical ventilation, but only18.1% required high-frequency oscillatory ventilation. Magnesium sulphate and sildenafil were used in 12 (16.7%) and 9 neonates (12.5%), respectively. Inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation treatments were not available. Of the 72 neonates, 25 (34.7%) died. The need for inotropic support was associated with a poor outcome (p=0.01). CONCLUSION. PPHN was uncommon in our unit, but its management proved challenging owing to the high mortality risk. The leading cause of PPHN was MAS. Consideration should be given to introducing iNO, given that extracorporeal membrane oxygenation (ECMO) treatment is expensive and labour intensive and probably not justified at this time. <![CDATA[<b>Ultrasonographic assessment of renal length in 310 Turkish children in the Eastern Anatolia region</b>]]> BACKGROUND. Kidney size varies with age in children. It is therefore clear that a standardisation of measurements by age group is required. OBJECTIVES. To determine the normal renal length of healthy children in the Eastern Anatolia region of Turkey using ultrasonography and to study the relationship between renal length and sex, age, body height and weight, repsectively. METHODS. A retrospective study of 310 children aged 0 - 16 years (150 girls and 160 boys) was performed. The children were divided into 11 age groups. Scanning was performed with a 3.5 MHz ultrasound probe in the supine position. The ultrasonographic appearance of the kidneys we measured was normal. The maximum length of each kidney was measured. The renal length was correlated with somatic parameters including age, body height and weight. Regression equations were derived for each pair of dependent and independent variables. RESULTS. No difference was found between the renal lengths of the boys and girls (p&gt;0.05). The mean left renal length was greater than the right renal length, and this difference was statistically significant (p<0.001). Renal length showed the strongest correlation with body height (r=0.966 and r=0.958 for the right and left kidneys, respectively; p<0.001). CONCLUSION. It is important to know the limits of kidney size on ultrasound examination. We found that renal length showed the strongest correlation with body height. The renal length can be calculated easily by deriving a linear regression equation. We hope that our study will be useful in daily routine ultrasonography. <![CDATA[<b>Neonatal HIV-associated nephropathy</b>]]> Human immunodeficiency virus (HIV)-related nephropathy is a significant cause of morbidity and mortality in HIV-1 seropositive children in Africa that presents at any age. To date the youngest patient reported in the literature was from our centre, presenting at 4 months of age. We present here a neonate born to an HIV-1 infected mother on combined anti-retroviral therapy (cART), who had vertical transmission of the virus and presented with congenital nephrotic syndrome at three weeks of life. The child was confirmed to have HIV-1 infection at 6 weeks. Kidney biopsy showed features consistent with HIV-associated nephropathy. On commencement of cART and angiotensin converting enzyme antagonist treatment, there was a substantial decrease in proteinuria. To the best of our knowledge, this is the first report of HIV-associated nephropathy presenting as congenital nephrotic syndrome.