Nigerian Journal of Paediatrics https://www.ajol.info/index.php/njp <p><span>The </span><em>Nigerian Journal of Paediatrics</em><strong><em> </em></strong><span>a quarterly journal publishes original articles, brief reports on clinical and laboratory observations; case reports of substantive value; invited editorial annotations; invited papers on recent electronic clinical briefs, advances, clinical diagnosis, announcements (meetings, courses, job advertisements); summary reports of conferences and book reviews.</span></p><p>Other websites associated with this journal: <a title="http://njpaediatrics.com/" href="http://njpaediatrics.com/" target="_blank">http://njpaediatrics.com/</a></p> en-US Copyright for articles published in this journal is retained by the journal. nigerianjpaediatrics@unizik.edu.ng (Prof Clement C Ezechukwu) editor-in-chief@njpaediatrics.com (Clement Ezechukwu) Thu, 11 Feb 2021 11:53:43 +0000 OJS 3.1.2.4 http://blogs.law.harvard.edu/tech/rss 60 Pattern of anaesthesia techniques for herniotomy at a southwestern tertiary health institution: a 5-year review https://www.ajol.info/index.php/njp/article/view/203574 <p><strong>Background:</strong> Anaesthesia for herniotomy may be challenging because the margin of error in managing such a young patient can be extremely small since the body reserves are limited and the organ systems may not be fully developed. Also, the psychological, physiological and pharmacological responses to anaesthesia are quite different from adult. Safe and effective care of children under anaesthesia is therefore crucial. This study aims to audit the pattern of anaesthetisia techniques used and their associated complications during herniotomy procedure in our health facility. <strong>Material and methods:</strong> This is a retrospective review of patients’ files, theatre records and anaesthetic-record charts of herniotomy cases performed in a tertiary health Institution from January 2011 to December 2015. Relevant clinical information were entered into proforma designed for the study. Data was analysed with descriptive statistics using the Statistical Package for Social Sciences (SPSS) version 20 Chicago IL (U.S.A). Inferential statistics of Chi-Square, Mann-Whitney and Kruskal-Wallis Test were alsoperformed. <strong>Results:</strong> One hundred and fortyfour in-patient children who belonged to American Society of Anesthesiologists Physical Health Status (ASA) grade I and II had herniotomies during the study period. The mean age is 4.21±3.72years (range, 6months – 16years) with male to female ratio of 47:1 (i.e 141 to 3). General anaesthesia (135, 94%) of various techniques was the most common technique while regional anaesthesia was only employed in nine (6%) children. The regional anaesthesia techniques were caudal block 1 (0.7%) and subarachnoid block 8 (5.5%) and were sedated to allow for cooperation in some of the cases. One hundred and twenty-four (86%) children presented as simple, elective cases while twenty (14%) children as complicated or emergency cases. <strong>Conclusion:</strong> This study showed that herniotomy can be safely performed under various options of anaesthesia techniques depending on the expertise of the anaesthetists involved. The simple, electives inguinal hernia and hydroceles could have been performed as day cases.</p> Emmanuel E. Ayodeji, Fatungase O. Motunrayo, Nwokoro C. Chigbundu, Shoyemi R. Oluwatoyin Copyright (c) https://www.ajol.info/index.php/njp/article/view/203574 Thu, 04 Feb 2021 00:00:00 +0000 Serum brain natriuretic peptide in healthy Nigerian newborn babies https://www.ajol.info/index.php/njp/article/view/203576 <p><strong>Background:</strong> Brain natriuretic peptide (BNP) is a sensitive biomarker that is valuable in the management of childhood heart failure. Studies have reported racial differences in the level of BNP, especially in the adult population. The level of BNP in healthy Nigerian newborn babies is unknown. Hence, we determined the level of BNP in healthy term appropriate for gestational age (AGA) newborn babies. <strong>Methods:</strong> This was a cross sectional study,85 healthy term AGA newborn babies aged 24 to 72 hours. The babies had relevant demographic parameters documented in a proforma and BNP assay analysed using ELISA method. <strong>Results:</strong> The median IQR serum BNP level was 341.43 (313.39 to 425.45) pg/ml. The median level in females, was higher than males, {393.86 (296.97- 460.62) pg/ml vs328.05 (313.61-389.39) pg/ml, p &gt;0.05}.There was no significant relationship between serum BNP and birth weight, chronological age, gestational age, or mode of delivery (p&gt;0.05 in each case). <strong>Conclusion:</strong> The study demonstrated high BNP levels in healthy term Nigerian newborns. There was no relationship between BNP, the chronological age, birth weight, gender, gestational age or mode of delivery in babies between 24 to 72 hours of life.</p> Amudalat Issa, Mohammed B. Abdulkadir, Omotayo O. Adesiyun, Bilkis Owolabi, Surajudeen O. Bello, Ruqayat R. Bakare Copyright (c) https://www.ajol.info/index.php/njp/article/view/203576 Thu, 04 Feb 2021 00:00:00 +0000 Placental Malaria histological features and the burden of congenital malaria among HIV/ malaria co-infected mothers in Benin City, Edo State https://www.ajol.info/index.php/njp/article/view/203578 <p><strong>&nbsp;Background:</strong> It is well documented that sub-Saharan Africa bears the highest burden of both malaria and HIV. Coinfection with both diseases is also well documented. Malaria parasites infecting the placenta lead to inflammation, intervillous fibrin deposition and infarction. This pathologic effect of malaria on the placental has led to the staging of placental malaria histology. These pathologic features may reflect different levels in the breach of the integrity of the placenta which may predispose to transmission of congenital malaria and possibly HIV. But few if any have examined the association of maternal placental malaria histology stages in HIV positive and negative mothers and the effects of these on their newborns (congenital malaria). <strong>Methods:</strong> Subjects were 162 newborns of HIV/malaria co-infected mothers and Controls were 162 newborns of HIV negative malaria infected mothers. Blood film for malaria parasites was done on cord blood and peripheral blood on days 1, 3 and 7 in the newborns. Maternal peripheral blood film for malaria parasite was done at delivery and placental tissue was obtained for confirmation of placental malaria by histology. Diagnosis of malaria in blood films was by light microscopy. <strong>Results:</strong> The placental malaria histology in HIV positive mothers were predominantly the chronic type (51.9%) and past type (54.6%) in HIV negative mothers respectively. Congenital malaria was significantly more in chronic types of placental malaria histology irrespective of maternal HIV status (p=0.017 in subjects and p= 0.000 in controls respectively) <strong>Conclusion:</strong> Babies born to mothers are at increased risk for congenital malaria if their placental malaria histology is of the chronic type compared to the other types (active and past) irrespective of maternal HIV status. This risk (chronic type) is highest in mothers with HIV; therefore, all babies born to HIV positive mothers should be screened for congenital malaria and managed as appropriate.</p> Fidelis E. Eki-udoko, Ayebo Sadoh, Michael O. Ibadin, Augustine I. Omoigberale Copyright (c) https://www.ajol.info/index.php/njp/article/view/203578 Thu, 04 Feb 2021 00:00:00 +0000 Predictors of breastfeeding practices among mothers in a developing African country – A tertiary facility based study in Calabar, Nigeria https://www.ajol.info/index.php/njp/article/view/203580 <p><strong>Introduction:</strong> Breastfeeding is essential for optimum childhood development. Although there is an increased awareness of the importance of breast milk, the Nigerian Demographic and Health Survey of 2018 showed that less than one-third (29%) of mothers in Nigeria practice exclusive breastfeeding. This may be attributed to several factors, hence the need for this study to assess the indicators and predictors of breastfeeding practices among mothers in a tertiary facility in Calabar, Cross River State. <strong>Methods:</strong> This cross-sectional study was conducted in the University of Calabar Teaching Hospital, Calabar, Nigeria. Consenting mothers of children aged six weeks to two years were sequentially recruited into the study using an interviewer-administered questionnaire. A test of association of categorical variables was done using Chi square test and pvalue was set at 0.05. <strong>Results:</strong> One hundred and twenty&nbsp;one children and their mothers were surveyed. Mean age of children was 6.2±3.8months and mothers was 28±25years. Exclusive breastfeeding rate for six months was 67.8%.Timely breastfeeding within one hour of life was 44.6%,ever breastfed rate was 86%. Practice of giving water alongside breast milk and use of breast milk substitute was 18.2% and 14.0% respectively. Mothers age was significantly associated with practice of exclusive breastfeeding (p=0.014) and giving water alongside breast milk (p=0.005) while birth order was associated with timely commencement of breastfeeding within one hour of life (p=0.022). <strong>Conclusion:</strong> The ever breastfed and exclusive breastfeeding rates were fairly high. However, the timely first suckling rate, increased use of breast milk substitute and giving of water alongside breast milk in the first six months of life were low. There is the need for continuous health education of mothers.</p> Joanah M. Ikobah, Kelechi Uhegbu, Iwasam E. Agbor, Ekong Udoh Copyright (c) https://www.ajol.info/index.php/njp/article/view/203580 Thu, 04 Feb 2021 00:00:00 +0000 A revised scoring scheme for the classification of socio-economic status in Nigeria https://www.ajol.info/index.php/njp/article/view/203582 <p><strong>Background:</strong> Researchers in medicine and related fields in Nigeria have usually made recourse to the instrument developed by Olusanya et al and Oyedeji in the past three-and-a half decades for determination of socioeconomic status (SES). Beside the question of their age, however, these instruments were purposive and might no longer be suitable because of the changes in the parameters on which they were based.<br><strong>Objective:</strong> To develop a robust but generic scheme that takes into consideration the changes in the nation’s socioeconomic space in the succeeding three and a half decades.<br><strong>Methods:</strong> A detailed and comprehensive review of the extant schemes was undertaken with a view to identifying their inherent weaknesses. The latter were then factored into the design of a new scheme taking into consideration the emergent restructuring of career positions in the civil/public service as well as the place of private and informal sectors of the economy. The new scheme was validated at the University of Benin<br>and Irrua Specialist Teaching Hospitals.<br><strong>Results:</strong> The new scheme had a remarkably high Inter-rater reliability (r = 0.947, p&lt;0.001), raterre- rater reliability (r = 0.984, p &lt;0.001) and % agreement (with modified Oyedeji’s tool as standard) of 67% (K coefficient = 0.47, r = 0.71, p&lt;0.001)<br><strong>Conclusion/Recommendation:</strong> The new scheme could be a viable tool for the assessment of SES of families and individuals, which not only takes into consideration current realities of the nation’s economy, but also is readily adaptable to meet foreseeable changes.</p> Michael O. Ibadin, George O. Akpede Copyright (c) https://www.ajol.info/index.php/njp/article/view/203582 Thu, 04 Feb 2021 00:00:00 +0000 What happens after helping babies breathe training is complete? A prospective cohort study of Nigerian health care workers https://www.ajol.info/index.php/njp/article/view/203584 <p><strong>Background:</strong> Neonatal mortality remains disturbingly high in Nigeria. Helping Babies Breathe (HBB) is an evidence- based neonatal resuscitation (NR) educational program designed to teach NR in resourcelimited areas. There is no information in Nigeria on what happens after health careworkers (HCWs) complete HBB training.<br><strong>Aim:</strong> To determine if HCWs who received HBB training utilized the acquired knowledge and skills (K&amp;S) and engaged in any ongoing peer training. In addition, we studied HCW turnover one year after HBB training completion.<br><strong>Subjects and Methods:</strong> Seventy-two HCWs were trained in HBB, and surveyed 1 year later using a 10-item questionnaire. Data analysis used measures of central tendency and t testing.<br><strong>Results:</strong> Most HCWs reported the use of HBB daily. The commonest NR method used was suctioning (89.5 %), followed by drying and positioning (86%), however there was 0% reported use of bagmask- ventilation. Most HCWs (98%) reported sharing K&amp;S with colleagues. Following training,<br>100% HBB trainers remained at original employment but 53% HBB providers moved to new employment and did not utilize their HBB K&amp;S at their new employment site.<br><strong>Conclusion:</strong> Frequent, brief, refresher practice sessions and implementation of a system for training new hires may improve HCW readiness for NR and their peer mentoring capabilities. Ensuring adequate equipment availability is critical for HCW to utilize acquired K&amp;S. Significant HCW turnover occurred within a year of training. Trained HCW who left to new employment subsequently had limited impact at their new place of employment.</p> Aneji U. Chiamaka, Okeke Chiemelu, Muomalu Chinwe, Agwu Ebere, Okoli Chimuanya, Umeh Rich, Ajah R.N. Uzoma Copyright (c) https://www.ajol.info/index.php/njp/article/view/203584 Thu, 04 Feb 2021 00:00:00 +0000 Peg pin in the duodenum of a four year old child: A Case report https://www.ajol.info/index.php/njp/article/view/203867 <p>Ingestion of foreign body occurs commonly in the paediatric age group particularly between 6 months and 5 years of age.1 Most ingested foreign objects pass smoothly through the oesophagus, into the stomach and are expelled from the body without complications. However, 10% –20% will require endoscopic removal to avoid complications. We present the endoscopic removal of a peg pin in the duodenum of a four-year-old child.</p> Ahmad B Kumo, Manko Muhammad, Habib Balarabe Copyright (c) https://www.ajol.info/index.php/njp/article/view/203867 Thu, 11 Feb 2021 00:00:00 +0000 Sulphonylurea responsive monogenic diabetes in an Insulin treated 8-year old child in West Africa; of more than academic interest and one of many? https://www.ajol.info/index.php/njp/article/view/203585 <p>We describe the case and identification of monogenic diabetes mellitus in a Togolese girl at the age of eight years, previously treated as Type 1 Diabetes following diagnosis at the age of two months. She has since been transitioned from insulin to oral sulphonylurea therapy, with improved glycaemic control and greater therapeutic security. We believe many more such cases must exist in Africa amongst those with a history of neonatal diabetes. Free genomic testing is available (see below) in suitable cases. The case highlights the value of personalized medicine and international cooperation.</p> L. Corley, K. Tossou, M. Amouzouvi-Sadji, E. De Franco, R. Firth Copyright (c) https://www.ajol.info/index.php/njp/article/view/203585 Thu, 04 Feb 2021 00:00:00 +0000 Idiopathic basal ganglia calcification (Fahr’s disease) in a 9-year-old Nigerian child https://www.ajol.info/index.php/njp/article/view/203586 <p>Fahr’s disease is a rare neurodegenerative disorder characterized by deposition of calcium on the walls of blood vessels of the Basal ganglia and Dentate nuclei of the Cerebellum. Patient can present with diverse array of symptoms including but not limited to seizure, extrapyramidal symptoms and mental retardation. We report a case of a 9-year-old female child with history of recurrent seizure. Brain CT showed symmetrical calcification in the basal ganglia.</p> Clifford O. Okike, Obinna C. Ajaegbu, Lazerus Origbo, Uzoamaka V. Muoneke Copyright (c) https://www.ajol.info/index.php/njp/article/view/203586 Thu, 04 Feb 2021 00:00:00 +0000 GM1-gangliosidosis in a Nigerian infant: A case report https://www.ajol.info/index.php/njp/article/view/203587 <p>Gangliosidoses belong to the group of genetic lipid metabolism disorders, caused by defects of lysosome enzymes, inherited as an autosomal recessive trait. Gangliosidosis GM1 is caused by the deficiency of the acid beta-galactosidase (GLB11) resulting in the storage of the substrate- GM1 ganglioside in brain and visceral organs. GM1 gangliosidosis comprises three phenotypes, depending on the age of onset: an infantile, juvenile and adult type. In the infantile type dysmorphic features, severe psychomotor retardation, hepatosplenomegaly, bone changes and a cherry red spot in the macular region are seen. The juvenile GM1 gangliosidosis has no such external distinguishing features. In the adult type behavioural problems, dementia, extrapyramidal problems are specifically prominent. The authors present symptoms, clinical course and laboratory findings of a one-year-old boy with a diagnosed GM1 gangliosidosis. He presented with skin rashes since birth, delay in achievement of developmental milestones, progressive weight loss and recurrent diarrhoea of six-months duration.</p> Sakina M. Abdullahi, Hafsat W. Idris, Halima A. Sadiku, El-ishaq Abubakar Copyright (c) https://www.ajol.info/index.php/njp/article/view/203587 Thu, 04 Feb 2021 00:00:00 +0000 Transient bulging fontanelle following rotavirus vaccination: A case report https://www.ajol.info/index.php/njp/article/view/203588 <p>Transient bulging fontanelle is a self-limiting clinical condition characterized by a bulging fontanelle with or without fever, which resolves without medical intervention. It is a relatively uncommon adverse event following immunization. We report a case of an 11 week old, otherwise healthy male infant who presented with a bulging, nontense anterior fontanelle without fever, which developed 11 hours after receiving rotavirus vaccine. Transfontanelle ultrasound scan findings were essentially normal. Two days later, the bulging anterior fontanelle resolved spontaneously. The child had normal neurological development and achieved corresponding developmental milestones over the subsequent eight months of follow-up. This case report highlights the importance of immunization history in the otherwise healthy infant who presents with bulging fontanelle. We recommend that in an otherwise well recently vaccinated infant that presents with bulging anterior fontanelle, lumbar puncture should be deferred while the infant is closely monitored.</p> Chinedu M. Dike, Bashir O. Oyeyemi Copyright (c) https://www.ajol.info/index.php/njp/article/view/203588 Thu, 04 Feb 2021 00:00:00 +0000 Natal teeth associated with ingestion of herbal medication in pregnancy: A case report https://www.ajol.info/index.php/njp/article/view/203589 <p>Significant alteration in timing of tooth eruption with the first teeth being present at birth or erupting during the first month of life is a rare occurrence in humans. Timing of tooth eruption may be affected by hereditary, endocrine and environmental factors. The presence of natal teeth may lead to complications such as discomfort during suckling, laceration of the mother’s breasts, sublingual ulceration with resultant feed refusal, and aspiration of the teeth making tooth extraction a management option in affected infants.</p> <p>This is to report a rare finding of eight markedly enlarged natal teeth in a post term male. His mother ingested different kinds of herbal medications prior to conception and during pregnancy. The report is aimed at raising questions about the possibility of a causal relationship between antenatal ingestion of herbal medications and occurrence of natal teeth.</p> Dorathy C. Obu, Ezeanosike B. Obumneme, Lilian N. Nwobashi, Linda O. Okoye Copyright (c) https://www.ajol.info/index.php/njp/article/view/203589 Thu, 04 Feb 2021 00:00:00 +0000