Open Access Case Report

Acute Osteomyelitis of the Posterior Column of the Acetabulum: About a Case

M. Jlidi, D. Selim, N. Jedidi, K. Khelil, Y. Trabelsi, K. Bouzaidi, A. Khorbi

Asian Journal of Pediatric Research, Page 1-8
DOI: 10.9734/ajpr/2018/v1i230091

Introduction: Acute osteomyelitis usually occurs in the metaphysis of the long bones, the lower limb being more commonly affected than the upper limb. Pelvic localization is rare.

Observation: An 11-year-old boy with no remarkable history of illness visited our emergency room complaining from high fever and atromatic right hip pain. The orthopedic examination objectified a limitation of the right hip joint motions especially in extension, the palpation of the groin’s crease was slightly painful without local inflammatory signs nor lymphadenopathies. Blood laboratory tests found an inflammatory syndrome. Hip X-rays did not show any abnormality, the ultrasound of the right hip showed a joint effusion of low abundance measuring 1 mm. Magnetic resonance imaging detected anhypointense signal on T1-weighted sequences and a high intensity signal on T2-weighted on the right acetabulum with contrast enhacement after gadolinium administration. It combines a fat infiltration and a collection of 13x6 mm in the internal obturator muscle. The diagnosis of acute osteomyelitis of the posterior column with soft tissue invasion and reactive arthritis was confirmed. The blood cultures did not isolate a germ and the urinalysis was negative. The child was given antibiotic therapy: amoxicillin clavulanic acid and fusidic acid intravenously for a period of 21 days and then orally for a total duration of 12 weeks. The evolution was marked by a clinical improvement and a negation of the CRP. A 3-month control MRI showed total regression of the soft tissue collections.

Discussion: Pelvic osteomyelitis is rare, patients with pelvic osteomyelitis can present various clinical signs, which gives place to late or erroneous diagnosis. The prognosis of pelvic osteomyelitis is very favorable. The rate of recovery without sequelae is greater than 95%, but decreases with late diagnosis and treatment failure.

Conclusion: Osteomyelitis remains an endemic pathology in Tunisia despite the development of diagnostic’ means and antibiotic therapy. Pelvic osteomyelitis is rare; it poses a diagnostic problem especially with Ewing's sarcoma. Its prognosis is favorable but decreases with a delay of antibiotic administration.

Open Access Original Research Article

Trend in Childhood Mortality in a Private Pediatric Hospital of Kisangani: A Descriptive Study

B. G. Mande, K. V. Muyobela, N. J. Mopepe, E. Maturu, K. E. Tebandite, S. D. Falay, L. B. Batoko, O. J. Alworonga, D. N. Ngbonda

Asian Journal of Pediatric Research, Page 1-6
DOI: 10.9734/ajpr/2018/v1i228799

Aims: To determine patterns of childhood mortality and its trends over a 4 years’ period in a private pediatric hospital. 

Study Design: A cross-sectional descriptive study.

Place and Duration of Study: Study conducted in the Nouveau Village de Pédiatrie (NVDP), in Kisangani town, Democratic Republic of Congo, between June 2014 and June 2018.

Methodology: Socio-demographic, clinical and biological data of children of 0-16 years were retrospectively recorded. Descriptive statistics were used to analyse patterns of childhood mortality and its trends during the four years’ period.

Results: From June 2014 to June 2018, 3789 children of 0 to 16 years were hospitalised in the Nouveau Village de Pédiatrie. The global mortality was 16.1% in 2014 and 2.4% in 2018. Mortality within 24 hours of admission was 58%. Neonatal mortality decreased from 22.4% in 2014 to 7.4% in 2018. The leading diagnosis was neonatal causes: sepsis, prematurity, neonatal asphyxia, severe, congenital abnormalities. Most of older children died from severe pneumonia, meningitis, severe anaemia and severe malaria. Severe pneumonia was the most frequent and common cause of children death in all ages.

Conclusion: Microbiological data, point of care exams, high quality antimicrobials and antibiotic stewardship in antimicrobial prescribing had a great impact in the significant reduction of childhood mortality in the Nouveau Village de Pédiatrie. Efforts must be focused on the reduction of neonatal mortality.

Open Access Original Research Article

Effect of Mobile Phone Reminders and Recalls on Missed Immunisations among Infants in Two Health Facilities in Abakaliki, Nigeria

N. C. Eze, B. N. Azuogu, I. L. Okoronkwo

Asian Journal of Pediatric Research, Page 1-8
DOI: 10.9734/ajpr/2018/v1i228803

Background: Missed immunisation (MI) may contribute to low immunisation coverage in diverse settings, especially developing countries. Receipt of vaccines at the recommended ages and intervals will ensure that children are adequately protected from target diseases at all times. Immunisation reminder and recall (RR) systems are cost-effective methods of improving adherence to recommended immunisation schedules. This study, therefore, determined the effect of immunisation reminders and recalls on reducing missed immunisations in Abakaliki.

Materials and Methods: This is a quasi-experimental study conducted among caregivers of infants in rural health facilities in Abakaliki. Mile-Four and St. Vincent hospitals located in Ebonyi and Izzi Local Government Areas (LGA) respectively in Ebonyi State were selected purposively. Mile-Four was assigned intervention group and St. Vincent as control group. The sample size was determined using the formula for comparing two proportions.  Caregiver-child pair was recruited during the infants’ BCG or Pentavalent vaccines 1 immunisation visit and followed till the final scheduled immunisation visit for each child. Data was collected using a questionnaire, proforma and checklist. Statistical Package for Social Science (SPSS) version 22.0 was used for analysis. Ethical approval was obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital Abakaliki (FETHA).

Results: A greater proportion of respondents in the intervention group (8.3%) missed vaccination at the 6th and 10th weeks when compared with the 4.1% and 6.9% for the above mentioned weeks respectively in the control group. In the control group, a greater proportion (22.1%) missed vaccination than the intervention group (8.9%) at the 14th week, a difference in the proportion that was significant (p=0.04). Relative to female caregivers, male caregivers are 6.2 times more likely to miss immunisation in the intervention group. They are 2.3 times more likely to miss immunisation than the female ones in the control group. Those at older age (≥30 years) are 1.2 times more likely to miss immunisation than those of younger age group.                                                                                             

Conclusion: Mobile phone reminders and recall has proven effective in reducing childhood missed immunisations and non-compliance in Abakaliki. Implementation of immunisation reminders and recall systems is therefore recommended in immunisation clinics in developing countries especially in Nigeria for immunisation timeliness and completion.

Open Access Original Research Article

Magnesium Sulphate Treated Severely Asphyxiated Neonates, Their Characteristic and Outcome

Simon Pius, Mustapha Bello, Jose Pwavimbo Ambe, Machoko Yenti, Rhoda Genesis, Adama Yusuf Clement, Mark Inusa Kamas

Asian Journal of Pediatric Research, Page 1-9
DOI: 10.9734/ajpr/2018/v1i230092

Introduction: Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. Encephalopathy occurs in 50% to 60% of patients with severe perinatal asphyxia. Moderate hypoxic ischaemic encephalopathy (HIE), 10% to 20% die and 30% to 40% develop neurodeficits, whereas 50% of those with severe HIE die and almost all survivors develop neurodeficits. The systematic administration of magnesium sulphate (MgSO4) after perinatal asphyxia has shown effective resolution of neuronal injury.  We have conducted this study to validate the effect of MgSO4 in severely asphyxiated neonates, so as to utilize its benefits on ameliorating the outcome associated with severe perinatal asphyxia/HIE.

Objective of the Study: To determine the characteristics and outcome of magnesium sulphate on neurological outcome in severe perinatal asphyxia

Materials and Methods: A prospective interventional study of magnesium sulphate treatment of neonates with severe perinatal asphyxia conducted over one year period from 1st August 2017 to 31st July 2018.

Results: Of the 52 neonates, male 34 while there 18 female giving a ratio of (M: F is 1:1.8).  There were 30 (57.7%) in-born and 22 (42.3%) out-born, the total asphyxia cases (30/144) giving the incidence of 20.8% among in born. About one half (55.8%) of the patients commenced MgSO4 therapy at < 6 hours after birth, while 30.6% and 16.6% commenced MgSO4 therapy at 6 - < 24 hours and > 24 hours after birth respectively. About one half (49.0%) commenced enteral feeding within 5 – 7 days while 36.7% and 14.3% commenced enteral feeding at 4 < days and at > 7 days respectively. Majority of the patients commenced full enteral feeding at either between 5 – 7 days or > 7 days while only 36.7% of the neonates commenced full enteral feeding before 5 days. Equally, primary outcome, fully recovered and initiation breast feeding.

Conclusion: Of the fifty two patients managed, 5 (9.6%) died during the treatment period after 8th day of admission and at follow up, while 47 (90.4%) survived. Also greater 50% of the survivors commenced breast feeding within five days of admission and were clinical normal at follow up clinic. Whether this coincidental or a true effect of MgSo4, a future prospective randomized controlled trial may make the picture clearer

Open Access Original Research Article

Causes of Illness and Preterm Infant Deaths in a Low Resource Setting in Southern Nigeria: A 5 Year Review

D. Briggs, P. Opara, M. Okpani, A. Eneh

Asian Journal of Pediatric Research, Page 1-7
DOI: 10.9734/ajpr/2018/v1i230093

Background: About 45% of deaths among under-fives occur during the neonatal period with a high contribution from preterm infant deaths. Regular evaluation of preterm deaths is important as patterns and therefore intervention may vary at different times and places.

Objectives: To determine the common causes of illness and death among preterm infants admitted to the Special Care Baby Unit (SCBU) of the University of Port Harcourt Teaching Hospital (UPTH), over a 5 year period.

Methods: This was a retrospective review of data of preterm babies admitted to the SCBU from 2012 – 2016. Information obtained included biodata, nature of illness, duration of admission and outcomes. Data were collated and analyzed using SPSS v20 for windows. 

Results: 3,071 babies were admitted in SCBU over the period, of which 683 (22.2%) were preterms. Of these, 421 (61.6%) were in-born while 262 (38.4%) were out-born. The male: female ratio was 0.9:1. Morbidity patterns varied with birth asphyxia (20%) ranking highest among in-borns while sepsis (21%) and neonatal jaundice (15%) were more prominent in out-borns. The overall preterm mortality rate was 24.6 % with rates being significantly higher in out-born 30.5% versus in-born 20.9% (p=0.004). Mortality was highest among low birth weight preterms. Admission rates decreased steadily over the period.

Conclusion: Birth asphyxia and sepsis were the main morbidities recorded. Mortality rates were higher among outborns. Low birth weight preterms were most affected because they were in the majority. There was a steady decline in admission rates. Improving obstetric care, neonatal resuscitation, infrastructure and subsidizing healthcare services for preterms is needful.