South African Journal of Child Health最新文献

{"title":"Neuroblastoma: Can lessons from the past help to improve the future?","authors":"L Coopoosamy, J Schoeman, DT Reynders, FE Omar, A Büchner","doi":"10.7196/sajch.2023.v17i1.1898","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1898","url":null,"abstract":"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.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-neonatal SARS-CoV-2 infection: A curious case of COVID‑19 with respiratory co-infection and treatment with surfactant","authors":"E Verster, None L-A, K Chetty, L Van Wyk","doi":"10.7196/sajch.2023.v17i2.1946","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1946","url":null,"abstract":"At the height of the COVID‑19 pandemic, South Africa became the epicentre of the continent. Considering the paucity of data onCOVID‑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.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breastfeeding and complementary feeding practices of mothers exposed to the Baby-Friendly Hospital Initiative in Limpopo Province","authors":"XG Mbhenyane, TC Mandiwana, HV Mbhatsani, NS Mabapa, LF Mushaphi, BA Tambe","doi":"10.7196/sajch.2023.v17i2.1917","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1917","url":null,"abstract":"Background. Appropriate infant feeding is crucial for growth and development of children in the first 5 years of their life. Despite theimplementation of the Baby-Friendly Hospital Initiative (BFHI), now known as Mother-Baby Friendly Hospital Initiative, exclusivebreastfeeding 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 inLimpopo Province. Data were collected using a validated questionnaire and analysed for 157 complete data sets using the StatisticalPackage 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%). Themain 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 breastfeedtheir 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 beforethe 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.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical spectrum of Staphylococcus aureus infections in children admitted to Chris Hani Baragwanath Academic Hospital, South Africa: A retrospective, descriptive study","authors":"P Raphulu (née Manenzhe), J Wadula, DP Moore, KL Petersen","doi":"10.7196/sajch.2023.v17i2.1937","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1937","url":null,"abstract":"Background. Staphylococcus aureus infection is associated with considerable morbidity and mortality. There are relatively few studiesdescribing 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 atChris 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 soughtfor 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%) infectionswere caused by methicillin-susceptible S. aureus (MSSA) and 80 (19%) by methicillin-resistant S. aureus (MRSA). Clinical data wereobtained for 286 (67.8%) cases, on which all further analyses were based. Clinical presentations for MSSA bacteraemia included skin andsoft 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 factorassociated 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 MRSAand S. aureus mortality rates in our setting.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134973436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of intussusception: The experience in Johannesburg, South Africa","authors":"V. Khumalo, A. Witthers, B. Jugmohan, C. Westgarth-Taylor, A. Grieve, D. Harrison, J. Loveland","doi":"10.7196/sajch.2023.v17i1.1924","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1924","url":null,"abstract":"Background. A previous study on intussusception from our institution demonstrated a pneumatic reduction (PR) rate of 33%, witha mortality rate of 9.1%. Numerous protocol changes were implemented, and as part of a national prospective observational study, asubsequent cohort of patients was compared with the initial series.Objectives. To compare our current series of children presenting with intussusception with our previous series. Specifically, we aimed tocompare PR rates, resection rates, morbidity and mortality.Methods. This was a retrospective review of patients aged <3 years who presented with intussusception to Chris Hani BaragwanathAcademic Hospital in Johannesburg, South Africa, from 2011 to 2015 (era 2). Clinical outcomes of patients and management modalitieswere reviewed. These were compared with results reported in the previous article (2007 - 2010, era 1).Results. A total of 111 patients were included. PR was attempted in 52 patients (46.8%). It was successful in 25 patients (48.1%) andunsuccessful in 27 (51.9%), with an overall success rate of 22.5%. Eighty-six patients (77.5%) underwent surgical intervention. Bowelresection was performed in 54/86 of the surgically managed patients. No deaths were reported during the era 2 study period.Conclusion. Despite improved protocols, we could not demonstrate an improvement in the proportion of attempted PR cases comparedwith our previous series, and we did not achieve better PR rates. This failure is thought to be due to the delayed presentation of our patients,as well as an aggressive approach to management. However, this aggressive management strategy has decreased our mortality rate to zero.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47279308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of infants requiring mechanical reventilation in those previously ventilated during the neonatal period","authors":"WV Nongaya, P Jeena","doi":"10.7196/sajch.2023.v17i2.1932","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1932","url":null,"abstract":"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), SouthAfrica, who were also ventilated during the neonatal period were compared with age-, gender-, timing-, and site-matched controls whowere not reventilated during infancy. Neonatal and postnatal records of the two cohorts and data on their clinical presentation andoutcomes 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 31non-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 noHIV-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 reventilationin infancy. Pneumonia, sepsis, CLD of infancy and UAO were common indications for reventilation post neonatal ICU discharge.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accidental poison exposure among children in a regional hospital in northern KwaZulu-Natal before and during the COVID-19 pandemic","authors":"R Vosloo, U Naidoo","doi":"10.7196/sajch.2023.v17i2.1954","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1954","url":null,"abstract":"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.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135140245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of indoor particulate matter and lung function in children from the Eastern Cape Province of South Africa","authors":"GA Engwa, C Anye, BN Nkeh-Chungag","doi":"10.7196/sajch.2023.v17i2.1926","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1926","url":null,"abstract":"Background. There is a dearth of information on the relationship between indoor air pollution and lung function, especially amongsub-Saharan African children.Objective. To assess the relationship between indoor particulate matter (PM) and lung function in children living in the Eastern CapeProvince of South Africa (SA).Methods. This cross-sectional study included 540 children aged 10 - 14 years and was conducted between May and September 2016. PMfrom 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 PM2.5 (39.45(26.38) μg/m3). PM2.5, PM5 and PM10 correlated negatively (p<0.05) with forced expiratory volume in 1 second (FEV1), forced vital capacity(FVC), FEV25-75, 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.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of β-2-microglobulin and cystatin C as urinary biomarkers of focal segmental glomerulosclerosis in the setting of paediatric HIV infection","authors":"K Persad, L Nandlal, R Bhimma, T Naicker","doi":"10.7196/sajch.2023.v17i2.1951","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1951","url":null,"abstract":"Background. Africa has the highest rate of HIV infection, and HIV-associated nephropathy (HIVAN) is one of the most frequent kidneydiseases observed in children. HIVAN in children usually presents as a form of nephrotic syndrome, predominantly focal segmentalglomerulosclerosis (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 HIVANand primary FSGS.Methods. The study group comprised 34 children; 14 with HIVAN and 20 with primary FSGS. The control groups were 20 HIV-positiveand 20 HIV-negative children with no kidney disease. Urine samples collected from these 74 children were stored at -80°C. Bio-Plextechnology 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. Urinarycystatin C levels were significantly increased in primary FSGS children compared with both HIV-negative (p=0.0041) and HIV-positivecontrols (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-positivecontrol groups.Conclusion. Urinary cystatin C has promising prognostic value to predict primary FSGS from HIVAN.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135140244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary nephrotic syndrome in children in Cape Town, South Africa","authors":"D Reddy, A Coetzee, K Webb, M McCulloch, P Nourse","doi":"10.7196/sajch.2023.v17i2.1945","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1945","url":null,"abstract":"Background. Histopathological patterns of childhood primary nephrotic syndrome (PNS) and clinical response to steroids have beenassociated 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 biopsiesat 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 between2006 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 of6.8 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 associationbetween 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 betweenrace and steroid response. Patients with FSGS were more likely to be black than mixed race when compared with MCD patients. Race wasnot otherwise significantly associated with any histopathological subtype","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}