Nigerian Journal of Paediatrics

Relationship Between Serum Vitamin A Levels and Maternal Education and Social Status Among Undernourished Children in Zaria

2024-04-14T09:26:22+00:00

Background: Vitamin A deficiency (VAD) affects an estimated 6 million preschool children in Nigeria and 20 million in Africa. The deficiency significantly increases childhood morbidity and mortality when associated with undernutrition.

Objective: To determine the relationship between serum vitamin A levels, maternal education, and social status among undernourished Nigerian children.

Methodology: This was a case-control, hospital-based, descriptive study of children aged 6-59 months carried out at the Institute of Child Health (ICH) Banzazzau, Zaria. The serum vitamin A level was assayed by high-performance liquid chromatography. Values below a cut-off, usually taken as 0.70 µmol/L (20 µg/ dl) and 0.35 µmol/L (10 µg/dl), defined as low serum vitamin A and vitamin A deficiency, respectively.

Results: Sixty-six children were recruited as the cases and age-matched controls. Eleven children in each group had low serum vitamin A levels. The three children with vitamin A deficiency belonged to the cases.

The overall mean serum vitamin A for the cases was 59.4412.93µg/dl, while it was 59.90±14.06µg/dl for the controls. The overall mean serum vitamin A levels based on maternal education were 57.26±16.2µg/dl for the cases and 61.02±5.36µg/dl for the controls (p = 0.01). The overall mean serum vitamin A levels based on social class were 59.36±7.38µg/dl and 61.67±6.74µg/dl for the cases and controls, respectively (p = 0.01).

Conclusion: The lowest mean serum vitamin A levels for the cases were recorded in the younger age groups compared to the controls. Maternal educational levels and social class greatly influenced their children's serum vitamin A levels.

Keywords: Childhood, Educational level, Retinol, Social class, Under-nutrition, Vitamin A.

Objective: To determine the relationship between serum vitamin A levels, maternal education, and social status among undernourished Nigerian children.

Conventional Oxygen Therapy in Childhood Emergencies at the Albert Royer National Children's Hospital in Dakar: A Retrospective Study

2024-04-14T09:33:07+00:00

Background: Conventional oxygen therapy is administered via various devices (nasal cannula, simple or high-concentration masks, face masks). It is currently the first stage in symptomatic acute respiratory failure (ARF) treatment before introducing non-invasive or invasive mechanical ventilation.

Objective: To evaluate conventional oxygen therapy techniques, the different indications, the duration of use and the outcome.

Methods: This retrospective study was conducted from January to July 2021 at the Albert Royer National Children's Hospital, Dakar, Senegal.

Results: The records of 129 patients were retrieved; this represented 14.4% of total admissions. The mean age was 32.28 months, and the sex ratio was 1.26. The leading diagnoses included bronchiolitis (34.11%), asthma (20.16%), and pneumonia (16.28%). The methods of conventional oxygen delivery included simple nasal cannulas (89.92%), simple masks (9.3%), and masks with high-concentration reservoirs (8.5%). The outcome was good in 83.72% of cases, while 16.28% died.

Conclusion: Conventional oxygen therapy is widely used to manage acute respiratory failure. The outcome remains generally good despite a notably high mortality rate, which may be due to the inadequacy of non-invasive oxygenation methods and diagnostic tools such as blood gas analysis.

Cord Blood Hepatic Enzymes as Biochemical Correlates of Hypoxic-Ischaemic Encephalopathy and Immediate Postnatal Outcome in Term Asphyxiated Babies

2024-04-14T09:50:58+00:00

Background: The untoward effect of perinatal asphyxia on newborns cannot be over-emphasised.

Objective: This study aimed to determine whether hepatic enzymes can serve as biochemical correlates of hypoxic-ischaemic encephalopathy (HIE) and immediate outcomes.

Methods: This cross-sectional study was conducted at the neonatal intensive care unit for 15 months among 70 asphyxiated and 70 healthy neonates. The clinical staging of HIE was based on the Sarnat and Sarnat classification system. A cord blood sample was obtained for the assay of Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), and Lactate dehydrogenase (LDH). The enzymatic assay was performed using the spectrophotometric method.

Results: There was a significant positive correlation between AST (r = 0.644, p <0.001), ALT (r = 0.364, p = 0.002), LDH (r = 0.377, p = 0.001), and the stages of HIE. AST correlated best with the severity of asphyxia (r = 0.644, p <0.001). Of the five mortalities in this series, the cord blood enzyme levels were significantly higher than in those that survived (p <0.05), and all the enzymes demonstrated a positive correlation with mortality, best with ALT (r = 0.354, p = 0.003).

Conclusion: The worse the degree of perinatal asphyxia in the newborn, the higher the serum hepatic enzymes. Elevation of serum hepatic enzymes may also be associated with the risk of death in such babies. Efforts should be made to prevent severe perinatal asphyxia, and when it becomes inevitable, appropriate and prompt management should be instituted to limit the risk of poor outcomes.

Paediatric Association of Nigeria Guidelines on the Management of Acute Chest Syndrome in Children with Sickle Cell Disease (2023)

2024-04-14T10:47:42+00:00

Acute Chest Syndrome (ACS) is a major cause of hospitalisation, a potentially life-threatening complication and a leading cause of mortality in children with Sickle Cell Disease (SCD). The affected child commonly presents with respiratory symptoms such as cough, breathlessness, chest pain, jitteriness, and confusion, with or without fever. The cause of this condition is multifactorial and sometimes unidentified, but the majority are due to infection, infarction, and fat embolism. ACS and its related complications may be minimised by prompt intervention and appropriate therapy, including the use of incentive spirometry and blood transfusion.

Objective

The development of a national guideline on the management of ACS in children with SCD under 18 years in Nigeria is meant to enhance early diagnosis and prompt treatment of ACS to improve the quality of care and clinical outcome and prevent death from ACS. It is intended to enhance the clinician's diagnostic capability and ensure that children with ACS receive the best available care.

Methods

This evidence-based guideline was adapted from the British Society of Haematology (BSH) and the American Society of Hematology (ASH) guidelines using the ADAPTE (Resource tool kit version 2.1) and AGREE II methods.

Results

The PAN Guideline Panel reached a consensus on 25 recommendations, three of which were modified and adapted for local use. The recommendations reflect a broad definition of ACS and a management approach, including blood transfusion and incentive spirometry, such as blowing latex balloons in the absence of a spirometer.

Conclusions

Most recommendations are conditional because of low-certainty evidence and closely balanced benefits and harms (benefits of therapy to patients and availability of such therapy). Patient preferences should drive clinical decisions. Randomised controlled trials and comparative-effectiveness studies are needed for optimal management of blood transfusion, fluid therapy, and use of oxygen.

Paediatric Association of Nigeria (PAN) Immunization Guidelines: An Update (2023)

2024-04-14T11:32:14+00:00

The Paediatric Association of Nigeria (PAN) Guidelines for Childhood Immunisation were first published in 2012 as a follow-up to a position paper submitted to the Nigerian government in 2008. These guidelines are long overdue for updating since their lifespan has exceeded the recommended five years. New evidence and information have accrued, and new vaccines have emerged to prevent old and new diseases. The updated guidelines, while ensuring compliance with international best practices, are intended to guide the use of vaccines in the country as a whole (both within the national guidelines and outside the national guidelines) as well as ensure that the use of vaccines is timely, comprehensive and in tandem with empirical evidence.

The updated guideline is intended for use by the Federal Ministry of Health, the Nigerian Immunization Technical Advisory Group (NITAG), the National Primary Health Care Development Agency (NPHCDA), Paediatricians and other healthcare workers in private and public institutions, parents, other key policymakers and vaccine funders.

Juvenile Xanthogranuloma with Ocular Manifestations in a Nigerian Infant: A Case Report

2024-04-14T10:03:36+00:00

Accurate diagnosis is the foundation of optimal care, which occasionally requires a multidisciplinary approach. Rare diseases may pose some diagnostic challenges, especially in the context of their similarity to other more common pathologies. We report a case of Juvenile Xanthogranuloma (JXG), a rare disease that had some initial diagnostic challenges due to its similarity with molluscum contagiosum.

A Suspected Case of Patau Syndrome in an Eight-week-old Male Infant: A Case Report and Review of Literature

2024-04-14T10:14:57+00:00

Patau syndrome is the third most common autosomal trisomy. It is the least common and most severe of the viable autosomal trisomies. This chromosomal disorder has a characteristic phenotype consisting of multiple congenital anomalies. We report an eight-week-old male infant who is the first child of a non-consanguineous marriage born at term with multiple congenital anomalies. He had an absent left eye and a sunken right eye, a cleft lip, a cleft palate, a mid-facial hypoplasia and a flat occiput. A cranial CT scan showed gross dilatation of both lateral and third ventricles with the absence of the septum pellucidum and fused frontal lobes. There was also marked attenuation of the cortical mantle.

Bilateral Chilaiditi Syndrome in a Nigerian Child with Severe Acute Malnutrition: A Case Report

2024-04-14T10:30:13+00:00

Abstract

Chilaiditi syndrome is characterised by abdominal pain, usually in the right upper quadrant, associated with a radiological finding of sub-diaphragmatic free air due to colonic interposition between the diaphragm and the liver. The Chilaiditi sign is the radiological finding of sub-diaphragmatic pneumoperitoneum due to colonic interposition between the diaphragm and the liver without any clinical symptom. It can be a source of diagnostic dilemma considering bowel perforation as a common differential leading to unnecessary exploratory laparotomy.

We report a four-year-old boy who presented with abdominal pain, fever, abdominal distension and diarrhoea with intermittent long-standing constipation. A plain abdominal radiograph in the erect position showed bilateral sub-diaphragmatic free air with associated haustration markings in free air. He was managed conservatively with antibiotics and nutritional rehabilitation with remarkable clinical improvement. While evaluating a child with an acute abdomen, the radiographic finding of free sub-diaphragmatic air, which is discordant with clinical signs, should heighten the suspicion of Chilaiditi syndrome. Knowledge of Chilaiditi syndrome is essential to avoid unnecessary surgical intervention while considering bowel perforation as a common cause of sub-diaphragmatic air.