South African Journal of Child Health

Accidental poison exposure among children in a regional hospital in northern KwaZulu-Natal before and during the COVID 19 pandemic

2024-01-26T08:20:47+00:00

Background. Poisoning has been reported as the fifth most common cause of injury-related deaths in children younger than five years worldwide. Little is known about accidental poison exposure among children at regional hospital level. Regional hospitals generally provide more specialised support to primary care facilities over a larger area. During the COVID‑19 pandemic, lockdown measures may have increased home-based unintentional poisoning.

Objectives. To determine the frequency, outcome and type of accidental poison exposure in children admitted to a regional hospital and compare cases before and during the COVID‑19 pandemic.

Methods. A review of admissions to Queen Nandi Regional Hospital in Empangeni was performed to document cases of accidental poison exposure over two years. Equal periods during 2019 and 2020 (April to December) were then compared. Children <13 years of age were included. Age, sex, date of admission, death or survival and type of poisoning were collected.

Results. Cases of accidental poison exposure made up a small proportion of the total admissions over two years (n=252/5 071, 4.97%) with a low case fatality rate (0.40%). Boys made up the majority (n=132/252, 52.38%). Most were <five years old (n=220/252, 87.30%). Medicines (n=114/252, 45.24%), hydrocarbons (n=59/252, 23.41%) and pesticides (n=26/252, 10.32%) were the main types of poison. Domestic cleaner-, sanitiser- and disinfectant-related admissions were significantly increased during the pandemic (p=0.020).

Conclusion. Accidental poison exposure occurs commonly in younger children. Medicines, hydrocarbons and pesticides made up the majority of cases. Domestic cleaner, hand sanitiser and disinfectant ingestion increased in the pandemic. Future research should involve primary care facilities, and risk factors as well as clinical severity should be investigated.

The role of β-2-microglobulin and cystatin C as urinary biomarkers of focal segmental glomerulosclerosis in the setting of paediatric HIV infection

2024-01-26T08:18:31+00:00

Background. Africa has the highest rate of HIV infection, and HIV-associated nephropathy (HIVAN) is one of the most frequent kidney diseases observed in children. HIVAN in children usually presents as a form of nephrotic syndrome, predominantly focal segmental glomerulosclerosis (FSGS) on histopathology, that often leads to chronic kidney failure.

Objective. This study determined the urinary concentrations of β-2-microglobulin (β2M) and cystatin C proteins in children with HIVAN and primary FSGS.

Methods. The study group comprised 34 children; 14 with HIVAN and 20 with primary FSGS. The control groups were 20 HIV-positive and 20 HIV-negative children with no kidney disease. Urine samples collected from these 74 children were stored at -80°C. Bio-Plex technology was used to analyse the urinary protein concentration of cystatin C and β2M.

Results. A significant increase in urinary β2M levels was observed in the HIVAN group compared with the HIV-negative group (p=0.0240). No other statistically significant differences in urinary β2M concentrations were noted across the study groups. Urinary cystatin C levels were significantly increased in primary FSGS children compared with both HIV-negative (p=0.0041) and HIV-positive controls (p=0.0256). Urinary cystatin C displayed a significant increase in the primary FSGS compared with the HIVAN group (p=0.0150). No significant differences in urinary cystatin C levels were noted in the HIVAN group compared with the HIV-negative and HIV-positive control groups.

Conclusion. Urinary cystatin C has promising prognostic value to predict primary FSGS from HIVAN.

Relationship of indoor particulate matter and lung function in children from the Eastern Cape Province of South Africa

2024-01-26T08:06:16+00:00

Background. There is a dearth of information on the relationship between indoor air pollution and lung function, especially among sub‑Saharan African children.

Objective. To assess the relationship between indoor particulate matter (PM) and lung function in children living in the Eastern Cape Province of South Africa (SA).

Methods. This cross-sectional study included 540 children aged 10 - 14 years and was conducted between May and September 2016. PM from 23 classrooms was measured with a handheld particle counter and lung function was assessed with a handheld spirometer.

Results. Mean (standard deviation) PM₅ levels were higher (109.96 (75.39) μg/m³) than PM₁₀ (84.84 (63.28) μg/m³) and PM_2.5 (39.45 (26.38) μg/m³). PM_2.5, PM₅ and PM₁₀ correlated negatively (p<0.05) with forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), FEV_25-75, as well as peak expiratory flow (PEF) but correlated positively (p<0.001) with the FEV₁/FVC ratio.

Conclusion. PM in classrooms showed a negative relationship with lung function in the study population.

Characteristics of infants requiring mechanical reventilation in those previously ventilated during the neonatal period

2024-01-26T08:10:02+00:00

Background. Factors predisposing ventilated neonates to the risk for reventilation during infancy are largely unknown.

Objective. To identify factors that predispose previously mechanically ventilated neonates to reventilation.

Methods. Mechanically ventilated infants at the Inkosi Albert Luthuli Central Hospital paedicatric intensive care unit (PICU), South Africa, who were also ventilated during the neonatal period were compared with age-, gender-, timing-, and site-matched controls who were not reventilated during infancy. Neonatal and postnatal records of the two cohorts and data on their clinical presentation and outcomes of the ICU admission were collected and analysed using descriptive and comparative statistics.

Results. Thirty-one reventilated index cases were identified at the PICU over a 15-month period and were matched with 31 non‑reventilated controls. Ex-preterm babies (n=26; 84%), males (n=19; 61.3%), chronic lung disease (CLD) of infancy (n=5; 16.7%) and prolonged neonatal length of stay (LOS) were common neonatal factors in reventilated neonates. Pneumonia (n=22; 71%), sepsis (n=11; 35.5%) and upper airway obstruction (UAO) (n=8; 25.8%) were common reasons for reventilation in neonates. There were no HIV‑positive cases. Of the 31 reventilated cases, 5 (16.1%) demised and 15 (57.6%) survivors had morbidities, commonly seizures (n=8; 30.8%) and short bowel syndrome (n=3; 11.5%).

Conclusion. Pre-term birth, male, CLD of infancy and prolonged LOS were associated with an increased risk for mechanical reventilation in infancy. Pneumonia, sepsis, CLD of infancy and UAO were common indications for reventilation post neonatal ICU discharge.

The clinical spectrum of Staphylococcus aureus infections in children admitted to Chris Hani Baragwanath Academic Hospital, South Africa: A retrospective, descriptive study

2024-01-26T08:11:47+00:00

Background. Staphylococcus aureus infection is associated with considerable morbidity and mortality. There are relatively few studies describing invasive S. aureus infections in children, particularly in low- and middle-income countries.

Objectives. To describe the clinical spectrum and outcomes associated with S. aureus infection in children <14 years of age hospitalised at Chris Hani Baragwanath Academic Hospital (CHBAH), South Africa, and to identify risk factors of invasive disease.

Methods. A retrospective, descriptive study was conducted at CHBAH to define the spectrum of clinical presentation, risk factors, duration of treatment and outcomes of paediatric S. aureus infections for the period January through December 2013. Data were sought for all children <14 years of age.

Results. Four hundred and twenty-two episodes of S. aureus infection were identified. Three hundred and forty-two (81%) infections were caused by methicillin-susceptible S. aureus (MSSA) and 80 (19%) by methicillin-resistant S. aureus (MRSA). Clinical data were obtained for 286 (67.8%) cases, on which all further analyses were based. Clinical presentations for MSSA bacteraemia included skin and soft tissue infection (45%), pneumonia (10%), meningitis (6%), bone/joint infections (5%) and urinary tract infections (3%). Five (8.3%) cases of MRSA were community-acquired. Admission to intensive care unit (ICU) was the only risk factor associated with MRSA infection (adjusted odds ratio (aOR) 125.55; 95% confidence interval (CI) 11.67 - 1 350.68). Hospital-acquired S. aureus infection was the only factor associated with mortality on multivariate analysis (aOR 8.70; 95% CI 1.55 - 48.77).

Conclusion. S. aureus is frequently isolated in paediatric bacterial infections. Closer attention to infection control would impact on MRSA and S. aureus mortality rates in our setting.

Breastfeeding and complementary feeding practices of mothers exposed to the Baby-Friendly Hospital Initiative in Limpopo Province

2024-01-26T07:50:41+00:00

Background. Appropriate infant feeding is crucial for growth and development of children in the first 5 years of their life. Despite the implementation of the Baby-Friendly Hospital Initiative (BFHI), now known as Mother-Baby Friendly Hospital Initiative, exclusive breastfeeding and complementary feeding practices remain barriers to optimal breastfeeding practices in South Africa.

Objectives. To explore the impact of the BFHI on breastfeeding and complementary feeding practices of mothers for second or subsequent pregnancies.

Methods. The study design was a cross-sectional survey and included 169 mother-baby pairs conveniently selected from clinics in Limpopo Province. Data were collected using a validated questionnaire and analysed for 157 complete data sets using the Statistical Package for Social Sciences version 26.0. Both univariable and multivariable logistic regression analyses were used to examine the impact of baby-friendly hospitals on breastfeeding practices of mothers.

Results. Few mothers in both groups practised exclusive breastfeeding for the recommended time (BFHI 22.2%; non- BFHI 30.6%). The main reasons for introducing early complementary foods were that the child was hungry, crying or was not satisfied with breastmilk. Mothers in the BFHI group were three times (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.13 - 10.98) more likely to breastfeed their infants, and two times (OR 2.22; 95% CI 1.08 - 4.58) more likely to initiate their infants on water with added glucose or salt before the age of 6 months than mothers in the non-BFHI group.

Conclusion. Mothers from the non-baby-friendly group had better breastfeeding practices. Evidence showed that for second or subsequent pregnancies, exposure to a baby-friendly facility during first pregnancy did not sustain appropriate breastfeeding and complementary feeding practices. Whether mothers were exposed or not, practices were similar. Strengthening and continual evaluation of breastfeeding interventions might improve impact on child survival outcomes in the study area.

Neuroblastoma: Can lessons from the past help to improve the future?

2024-01-26T07:47:24+00:00

Background. The outcome of patients with neuroblastoma in South Africa has always been very poor. We conducted a retrospective study in one state-funded paediatric oncology unit (POU), to describe the clinical course, evaluate prognostic factors and report outcomes of patients with neuroblastoma.

Methods. We analysed routine data from one POU, gathered between 1993 and 2018. Kaplan-Meier curves were used to illustrate 2-year survival rates and to evaluate possible prognostic factors.

Results. Data from 87 patients were included and analysed. The median age was 41 months. The majority of the patients presented with stage 4 disease (77%). The most common presenting symptoms were bone pain, loss of weight, and abdominal distention. Chemotherapy was administered to 74 patients, and only 5 patients (6%) received palliative chemotherapy as first-line treatment. Only 18 of the 87 patients had surgery (21%) and 13 of 87 had radiation (15%), while 10 patients received palliative radioactive iodine (131I-miBG) therapy. Patients with ferritin levels >120 ng/dL did not have a poorer outcome, and those with a raised lactate dehydrogenase (LDH) level displayed a shorter survival time but it was not statistically significant. The 2-year overall survival was 24% for the whole cohort and 16% for the stage 4 patients at diagnosis.

Conclusion. Neuroblastoma is a disease with a dismal outcome in our POU, mostly as a result of late presentation. To improve prognosis the focus should be on recognising danger signs to ensure early diagnosis and referral. We recommend adding danger signs for childhood cancer to the Integrated Management of Childhood Illness (IMCI) strategy in an attempt to improve early recognition and diagnosis of childhood cancer.

Primary nephrotic syndrome in children in Cape Town, South Africa

2024-01-26T07:44:01+00:00

Background. Histopathological patterns of childhood primary nephrotic syndrome (PNS) and clinical response to steroids have been associated with certain race groups in parts of South Africa. However, there are no recent studies of childhood PNS in Cape Town.

Objectives. To describe the demographics, histological subtypes and steroid response of patients with PNS who underwent kidney biopsies at Red Cross War Memorial Children’s Hospital (RCWMCH) over a 10-year period.

Methods. Details of patients with PNS who underwent kidney biopsies in the Paediatric Nephrology Department at RCWMCH between 2006 and 2015 were retrospectively recorded.

Results. A total of 103 patients were included in the study. Most patients were either of mixed race (42%) or black (36%), with a mean age of 6.8 years and a male-to-female ratio of 1.19:1. The most identified histopathological subtype was mesangioproliferative glomerulonephritis (MesPGN; 60% (n/N=62/103)). Of the patients with focal segmental glomerulosclerosis (FSGS), MesPGN and minimal change disease (MCD) 45% (n/N=43/95) were steroid-resistant, and 54% (n/N=51/95) were steroid-sensitive. There was no significant association between any race group and steroid response. Patients with FSGS were more likely to be black, while MCD was more common in mixed-race patients (p=0.04). There was no difference in the likelihood of being mixed race or black between patients with FSGS and MesPGN (p=0.472).

Conclusion. MesPGN was the most common histopathological subtype found in our study. There was no significant association between race and steroid response. Patients with FSGS were more likely to be black than mixed race when compared with MCD patients. Race was not otherwise significantly associated with any histopathological subtype.

Trends in childhood cancers at Tygerberg Hospital from 1994 to 2014

2024-01-26T08:14:08+00:00

Background. There is a paucity of data regarding childhood cancer incidence in low- and middle-income countries owing to a lack of disease-specific, hospital- and population-based registries.

Objective. To describe the disease profile and outcome of children with cancer, treated at a single institution in South Africa between 1994 and 2014.

Methods. Data collected included demographic data (age at diagnosis, sex, stage or risk group, race) and 5-year overall survival (OS) of children aged ≤15 years diagnosed with cancer. Time to event and factors associated with 5-year outcomes were analysed, using Kaplan- Meier curves and Cox regression analysis.

Results. The most common malignancies were leukaemia (27.7%), brain tumours (18.4%), lymphomas (14.1%), nephroblastoma (8.0%) and soft-tissue sarcomas (7.4%) for 935 patient records. Limited-disease solid tumours and standard-risk haematological malignancies had good OS rates of 77.7% and 85.9%, respectively, although OS for the whole group was 60.2%. Nephroblastoma (89.3%), retinoblastoma (86.7%), Hodgkin’s lymphoma (89.7%) and Burkitt lymphoma (75.5%) had the best OS. Type of cancer (p<0.01), solid-tumour stage (p<0.001) and risk classification for haematological malignancies (p<0.001) were significantly associated with mortality.

Conclusions. Underlying cancer diagnosis, stage and risk group remained significant factors influencing survival with good OS for limited disease in solid tumours and standard-risk haematological malignancies, which was comparable with survival rates in high-income countries.

Late-neonatal SARS-CoV-2 infection: A curious case of COVID 19 with respiratory co-infection and treatment with surfactant

2024-01-26T08:16:32+00:00

At the height of the COVID‑19 pandemic, South Africa became the epicentre of the continent. Considering the paucity of data on COVID‑19, we aimed to describe the clinical picture in a neonate, alert healthcare workers to the presence of co-infection with COVID‑19 and propose alternative treatment modalities. The use of surfactant was based on the pathophysiological mechanisms of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). There is mounting evidence in support of using surfactant in the management of severe COVID‑19. While viral co-infection is a common occurrence among neonates, our case shows that COVID‑19, together with rhinovirus infection, may result in a more rapid clinical deterioration, as opposed to rhinovirus infection in isolation.