Nigerian Journal of Paediatrics

Chronic Encapsulated Intracerebral Haematoma in a Two-Month-Old Infant Following Forceps-Assisted Delivery: A Case Report

Samson E Obirija — 2025-01-24

Chronic encapsulated intracerebral haematoma is a rare form of intracerebral haematoma that grows progressively. It is usually laden with diagnostic challenges, and only a few cases have been diagnosed preoperatively. This report is about an eight-week-old male infant who presented with a history of fever, excessive crying, multiple seizure episodes and loss of consciousness. He was delivered with forceps assistance. Transfontanelle ultrasonography showed an oval encapsulated hyperechoic mass in the left frontal lobe, associated compression of the adjacent limb of the anterior ventricle, and mild intraventricular hyperechoic collection. Magnetic resonance imaging of the brain revealed a well-defined encapsulated mass in the left frontal lobe extending and compressing on the adjacent lateral ventricles with a significant midline shift to the contralateral side. Thus, a diagnosis of encapsulated intracerebral haematoma was made. The infant had a craniotomy, and the lesion was excised en bloc. The histological analysis was consistent with blood clots. This case report highlights one of the possible complications of forceps-assisted delivery. A comprehensive history and thorough clinical examination with a multidisciplinary approach should be constituted for prompt and appropriate treatment.

A Review of Neonatal Morbidity and Mortality in a Tertiary Healthcare Facility in Yenagoa, Nigeria

Chinelo J Ozigbo — 2025-01-24

Background: Audit of facility-based morbidity and mortality patterns helps to improve the quality of care.

Objective: To audit and establish baseline data on neonatal morbidity and mortality patterns in a Tertiary Facility in southern Nigeria.

Methods: This retrospective study was conducted at the Special Care Baby Unit (SCBU) of the Federal Medical Centre, Yenagoa. The hospital records of babies admitted during the three years under review were retrieved for statistical analysis.

Results: Of the 409 records available for review, there were 236 (57.7%) males and 173 (42.3%) females. There were 177 (43.3%) in-born babies and 232 (56.7%) out-born babies, with 239 (58.4%) preterm babies and 156 (38.1%) having≥ 37 completed weeks of gestation. Neonatal sepsis was the commonest morbidity in 104 (25.4%) babies, followed by perinatal asphyxia in 93 (22.7%). Perinatal asphyxia was the commonest cause of mortality, with 48 (32.7%) deaths and 34 (23.1%) in neonatal sepsis. Two hundred and sixty-two babies (64.1%) were discharged home, while 147 (35.9%) died.

Conclusion: The facility-based neonatal mortality rate of 35.9% is unacceptably high. Neonatal sepsis and perinatal asphyxia were the leading causes of morbidity and mortality in this facility. Therefore, the level of preparedness to manage these conditions must be optimised.

Prevalence and Factors Associated with Intellectual Disability Among African Children with Epilepsy

Aderonke O Uhunmwangho-Courage — 2025-01-24

Background: Sub-Saharan Africa contributes significantly to the people living with disability, including epilepsy and intellectual disability (ID) in Low- and middle-income countries (LMIC). Epilepsy is already associated with treatment gaps, stigma and poor Health-Related Quality of Life (HRQoL) in sub-Saharan Africa. Still, the impact is more significant when children living with epilepsy also have ID.

Objective: To assess the prevalence and factors associated with intellectual disability among children with epilepsy (CWE).

Methods: This cross-sectional study was conducted among CWE aged 15 months to 18 years compared to 100 age and sex-matched controls without epilepsy. The Vineland Adaptive Behavioural Scale II was used to detect intellectual disability.

Results: Each group consisted of 55 males and 45 females with median (IQR) ages of 8 (4-13) and 9 (5-13) years in CWE and controls, respectively. The prevalence of intellectual disability among CWE (36%) was significantly higher than the prevalence of epilepsy in the control group (2%) (p<0.001). Factors associated with the presence of ID among CWE include the onset of epileptic seizures before the age of one year (Χ²= 16.07, p = 0.001), polytherapy (Χ²= 8.375, p = 0.004), severe seizures (Χ²= 4.63, p = 0.031), non-school enrolment (Χ²=31.62, p = <0.001).

Conclusion: The prevalence of ID is high among children with epilepsy. Those with early seizure onset or severe seizures and those on polytherapy deserve closer attention, and screening for ID should be routinely conducted in CWE.

Cerebral Artery Blood Flow Velocities in Children with Sickle Cell Anaemia at the Federal Teaching Hospital, Owerri

Lilian C Ezeuko — 2025-01-24

Introduction: Vaso-occlusion in Sickle Cell Anaemia (SCA) results in the narrowing of the major cerebral blood vessel, predisposing affected children to cerebrovascular accidents (CVA). The risk of CVA can be assessed with cerebral blood flow velocities measurement using a transcranial Doppler ultrasound.

Objective: To determine the cerebral blood flow velocities in children with SCA aged 2-16 years.

Methods: This was a hospital-based, cross-sectional study of children with SCA conducted between April and September 2023. Transcranial Doppler ultrasound was used to assess the anterior and middle cerebral arteries.

Results: A total of 102 children out of the 150 enrolled were screened within the study period. The values obtained from this procedure were categorised as abnormal (≥200cm/s), conditional (170 – 199cm/s) and normal or standard risk (< 170cm/s). Children with abnormal blood velocities are at high risk of CVA, while children whose velocities fall within the conditional range are at moderate risk for CVAs. The prevalence of abnormal cerebral blood flow velocity above 170cm/second was 17.6% (13.7% was in the conditional risk zone and 3.9% in the high-risk zone). All the subjects in the high-risk zone were aged 2-6 years, and 75% were females.

Conclusion: The prevalence of abnormal cerebral blood flow velocity in the cohort of SCA children is 17.6%, with 10-40% annual risk for stroke. Identification of children at risk for a CVA helps in the primary prevention of CVA by prompt therapy institutions.

Black Sock Tops: Effective Low-Cost Eye Shields for Phototherapy

Sophia J Park — 2025-01-24

Background: In low-resource settings, there is often a challenge with sourcing effective eye protection for newborns undergoing intensive phototherapy as treatment for neonatal jaundice.

Objective: To evaluate the efficacy of sock tops as an eye-shielding alternative for use in intensive phototherapy.

Methods: This study evaluated the efficacy of black, gray, and white thick, elastic, sock tops in various materials as eye-shielding alternatives for use in intensive phototherapy.

Results: Wool, cotton, and polyester black sock tops provided acceptable levels of shielding at all levels of irradiance when layered. However, white and gray sock tops in the same material did not provide adequate shielding, even when layered.

Conclusion: Black sock tops may provide an accessible, low-cost alternative to commercial eye patches in low-resource settings, especially when confirmatory testing with an irradiance meter is available.

Putative Mechanisms of Immune Dysfunction in the Pathogenesis of Type 1 Diabetes Mellitus: A Scoping Review

Michcael T Okafor — 2025-01-24

Type 1 Diabetes Mellitus is a complex disorder characterized by autoimmune destruction of insulin-producing pancreatic beta cells. Immune dysfunctional mechanisms underlying its pathogenesis remain elusive. Immuno-toxic lifestyle habits (poor diet, inadequate sleep and lack of exercise) contribute to the pathogenesis of Immune-Mediated Inflammatory Diseases (IMIDs). There are disease models of T-cell dysfunction that describe the systemic inflammatory disease processes that underlie IMIDs. These disease models do not highlight the roles of immunotoxins in the disease pathogenesis. Online searches were conducted on databases such as Google Scholar, PubMed, Biomed Central, and SciELO. Articles were reviewed using keywords such as Immune optimization/dysfunction, T cell activation/dysfunction, cytokines, Type 1 DM, cellular adhesion molecules and inflammatory pathogenesis. This review proposed a putative immune dysfunctional disease model for Type 1 DM, which multi-omic studies may validate. Insights from the putative disease model can guide effective therapeutic interventions.

Educational Series: Hydroxyurea Use in Children with Sickle Cell Disease, Congestive Cardiac Failure in Children, Management of Coma in Children and Oesophageal Atresia

Samuel A Adegoke — 2025-01-24

Sickle Cell Disease (SCD) is a global health problem, although about 90% of the burden occurs in Low-and Middle-Income Countries (LMICs). Globally, about 300,000 babies are born with the disease annually, with about 150,000 of them in Nigeria alone. The Nigeria 2018 Demographic Health Survey estimated the average birth prevalence of homozygous sickle cell disease (HbSS) as 1·21% and 0·24% for the heterozygous state HbSC.^1,2 SCD is a single gene mutation characterized by GAG to GTG transversion resulting in the replacement of soluble glutamic acid by insoluble valine at the sixth position of the β-globin chain (β6 Glu →Val, GAG>GTG).³ Clinically, it typically manifests as episodic ischaemia and hypoxia, resulting in recurrent pains (the disease hallmark), chronic haemolysis and increased predisposition to infections.