Nigerian Journal of Paediatrics

Foetal Alcohol Syndrome in a Nigerian Infant: A Case Report

Tolulope Ogundele — 2024-07-15

Foetal Alcohol Syndrome (FAS) is the most severe form of foetal alcohol spectrum disorder (FASD). Alcohol and its metabolite, acetaldehyde, interfere with foetal development by disrupting cellular differentiation and growth, DNA and protein synthesis, and inhibiting cell migration. The diagnosis is based on the history of maternal alcohol consumption, characteristic facial anomalies, growth retardation, and central nervous system (CNS) involvement.

The syndrome is a leading cause of intellectual disability in the United States, but no such data is available in Nigeria. This is a report of a case of a term female neonate, delivered at approximately 38 weeks gestation through emergency Caesarean section. The mother consumed several bottles of 250ml of alcohol (local gin) from the second week of pregnancy to the tenth week to terminate the undesired pregnancy. At birth, the infant had short palpebral fissures, low-lying ears, a smooth philtrum, a flattened nasal bridge, a very thin upper lip, and a high-arched palate. The birth weight was 2.48kg, the occipitofrontal circumference was 33cm, and the length was 48cm. The infant was discharged seven days after admission with a weight of 2.35kg and was followed up at the outpatient clinic. Two weeks after discharge, despite adequate feeding through exclusive breastfeeding and supplemental expressed breast milk, the infant’s body weight further dropped to 2.2kg.

A Narrative Review of Calcium, Phosphate, Magnesium and Vitamin D Metabolism in Breastfed Preterm Babies

Victor A Ayeni — 2024-07-15

Calcium, magnesium, phosphate and Vitamin D metabolism is intricately interwoven in human beings. For the foetus, the accretion of these nutrients occurs mainly in the third trimester. Hence, babies who are delivered preterm are at risk of suffering a deficiency of these micronutrients. Inadequate micronutrients can impair the infants' cellular functions, growth and development. Hence, this paper reviews the determinants of plasma levels of the micronutrients and how they are mobilised. It also reviews the evidence about the quantities of the nutrients available in breast milk and how much of them are available to the infant at optimal breastfeeding volumes. The possible implications on growth and the argument for or against supplementation of the nutrients in pregnant women and their preterm neonates who are exclusively breastfed are also discussed.

55th Annual General and Scientific Conference of the Paediatric Association of Nigeria (PANCONF), 17th to 19th January 2024

Tinuade Ogunlesi — 2024-07-15

Abstracts presented at the 55th Annual Scientific Conference of the Paediatric Association of Nigeria in January 2024 in Lagos, Nigeria.

Educational Series 2024

Felix O Akinbami — 2024-07-15

Synopsis: Neonatal Cholestasis

Excerpts from Webinar: Overview of Acute Kidney Injury in Children

Excerpts from Webinar: Management of Acute Kidney Injury

Clinical Quiz

Antibiotic Use in Home Treatment of Childhood Diarrhoea in Uyo, Nigeria0

Ekong Udoh — 2024-07-15

Background: Diarrhoea is a common reason for hospitalisation among under-fives. Caregivers often administer medications, including antibiotics before hospitalisation.

Objective: To determine the pattern of antibiotic use by caregivers before hospitalisation of under-fives with diarrhoeal diseases.

Methods: This was a descriptive, cross-sectional study of under-fives admitted for diarrhoea at the University of Uyo Teaching Hospital, Uyo. A validated semi-structured questionnaire was used to obtain information on diarrhoeal illness in the children and home treatment by caregivers.

Results: One hundred under-five children were enrolled in the study. Of these, 75 (75.0%) had acute watery diarrhoea, 22 (22.0%) had dysentery, and 3 (3.0%) had persistent diarrhoea. Caregivers administered antibiotics to 32 (32.0%) children. Twenty-five children (78.1%) received a single antibiotic, while 7 (21.9%) received multiple antibiotics. Metronidazole 10/39 (25.6%), Amoxicillin 9/39 (23.1%) and Cefuroxime 5/39 (12.8%) were the most frequently administered antibiotics. The rate of antibiotic use was high in children of high social class and those with dysentery. The association between diarrhoea type and unwarranted antibiotic use by caregivers was statistically significant (χ² = 4.127; p = 0.04).

Conclusion: About one-third of the caregivers administered antibiotics in home treatment of childhood diarrhoea. Metronidazole, amoxicillin and cefuroxime were the most frequently used antibiotics. Antibiotic use was related to social class and children with dysentery. The type of childhood diarrhoea was significantly associated with unwarranted use of antibiotics.

Paediatric Emergency Admissions, Mortalities, and Unmet Intensive Care Needs at a Tertiary Hospital in Southern Nigeria

Fidelis E Eki-Udoko — 2024-07-15

Background: The essence of seeking medical services is to be provided with essential medical care to prevent complications and possibly death from the illness.

Objective: To examine the pattern of admissions into the Children’s Emergency Room and unmet intensive care needs in a tertiary health facility.

Methods: This prospective, cross-sectional study was conducted at the University of Benin Teaching Hospital (UBTH), Benin, Nigeria, over a 24-month period (2018 – 2019).

Results: A total of 10 138 children presented to the children's emergency room, and 2 914 children (28.6%) were admitted. There were a total of 144 mortalities (4.94%) of the total admissions. Infectious diseases accounted for the Majority of the deaths. The commonest morbidity necessitating admission was meningitis, while the sickle cell crisis and oncologic pathologies contributed the least - most children presented with multiple morbidities. The under-5s made up 61.1% of deaths recorded. More deaths amongst males compared to female children (1.3:1.1). Majority of the deaths occurred within 12 hours of presentation. Of the 144 mortalities recorded, 140 (97.2%) required intensive care services, while four did not qualify for ICU care. Of the 140 children who qualified for ICU care, 17 (12%) were admitted into the ICU for further care, of which only 2 (12.3%) survived and were discharged home. The others died.

Conclusion: The persistently high contribution of infectious disease to infant and child mortality, coupled with an inability to offer intensive care services, should be an important consideration for health planners and administrators.

Evaluation of the pattern of referrals to a Paediatric Emergency Unit in relation to the outcome of care in Benin City

Fidelis E Eki-Udoko — 2024-07-15

Background: The referral system is a process where a patient is moved from one level of care to a higher or better level of care for appropriate treatment. Healthcare workers usually initiate referrals, which should be accompanied by a referral letter.

Objective: To evaluate the pattern and content of referral notes received in a children’s emergency unit at a tertiary facility in Benin City.

Methods: Over six months, a cross-sectional study reviewing all referral notes accompanying children to the Paediatric Emergency Unit of the University of Benin Teaching Hospital, Nigeria was done.

Results: Two hundred and six of 300 children (68.7%) had formal written referral letters, while 94 (31.3%) had verbal referrals. Eighty-nine per cent were initiated by healthcare personnel, while clients were initiated in 33 (11.0%) of cases. Doctors made referrals in 238 (79.3%) cases, while 26 (8.7%) referrals were made by nurses. Doctors (182; 76.5%) were more likely to write referrals compared to nurses (9; 31.0%) (χ²= 32.3, p<0.001). Referrals from medical doctors had significantly better content, including complaints, examination findings, diagnosis investigations, treatment and reason for referral, hospital, name and qualification of doctor (p <0.05). Referral type, source and referring personnel did not significantly affect the mortality of the children (p = 0.24, 0.70, 0.41 respectively).

Conclusion: Referrals were more frequently documented and the contents were more comprehensive when written by doctors.

Association of Undernutrition with Acute Diarrhoea and Recent Hospitalisation Among Primary School Children in Nnewi, Southeast Nigeria

Nkechinyere G Obichukwu — 2024-07-15

Background: Undernutrition is a major predisposing factor to common childhood infectious diseases. It contributes to about half of the deaths of children worldwide, especially in low-income countries. The prevalence of childhood undernutrition is still high despite implementing informed and directed interventional strategies. It is plausible some important aetiological factors may not yet be in focus.

Objective: To explore the relationship between acute diarrhoea and a history of recent hospitalisation for common childhood diseases and undernutrition.

Methods: This observational, cross-sectional study was conducted on 244 primary school pupils aged 6-12 years in Nnewi, southeast Nigeria. Socio-demographic and other relevant clinical details related to recent diarrhoeal episodes and hospitalisations were collected using an interviewer-administered questionnaire. The anthropometric parameters were used to determine the nutritional status using the World Health Organization (WHO) growth charts.

Results: More than half (133; 55.3%) of the participants were males, and most (106; 43.5%) belonged to the low socio-economic classes (SEC). More than half (135; 54.5%) were aged 6-8 years. Low SEC, acute diarrhoea and hospital admission in the preceding six weeks were significantly associated with undernutrition (p <0.001).

Conclusion: Acute diarrhoea and recent hospitalisation in the preceding six weeks were associated with undernutrition among primary school children in Nnewi, southeast Nigeria. Prompt treatment of acute diarrhoea to reduce its duration and prevention of common ailments that lead to hospitalisation may help reduce the incidence of childhood undernutrition.

Disclosure Rate and the Associated Factors Among Adolescents Living with the Human Immunodeficiency Virus in Gombe Metropolis, Nigeria

Ezra G Daniel — 2024-07-15

Background: Disclosure of Human Immunodeficiency Virus (HIV) status is one of the major challenges in the management of children and adolescents living with HIV (CALHIV). Disclosure has been shown to positively impact adherence to antiretroviral therapy and retention in the care of CALHIV. With the increasing number of adolescents living with HIV (ALHIV) and the peculiarities of adolescence, there is a need for local data on the disclosure of HIV status among ALHIV.

Objectives: To determine the disclosure rate in HIV infection and the associated factors among ALHIV in Gombe Metropolis.

Methods: This cross-sectional study was conducted over ten months among 130 ALHIVs aged 12-18 who attended Antiretroviral Therapy Clinics at the Federal Teaching Hospital and the State Specialist Hospital in Gombe, Nigeria. Disclosure of HIV status was assessed using a pre-tested semi-structured questionnaire administered to adolescents and their respective caregivers.

Results: The HIV status disclosure rate by caregivers' report and self-report was 66.2% and 63.1%, respectively. Older adolescents' age and higher level of education were significantly associated with disclosure (p < 0.05). The commonest reason for disclosure was 'increasing curiosity' (23/130; 26.7%), while 'being too young' was the commonest reason for non-disclosure (19/44; 43.2%).

Conclusion: The disclosure rate among ALHIV in Gombe Metropolis was relatively high. Caregivers should be encouraged to disclose early.