Open Access Case Study

A 3-Year Physiotherapy Management of a Case of Spinal Poliomyelitis Referred at Three Months Post Paralysis

Uchenna Prosper Okonkwo, Joseph Onuwa Umunnah, Chima Collins Ihegihu

Asian Journal of Pediatric Research, Page 1-10
DOI: 10.9734/ajpr/2019/v2i130095

Background: Poliomyelitis is known to bring about huge complications that foist debilitating disabilities on a patient with poliomyelitis. Most post-polio survivors live with disabilities throughout a lifetime with an attendant social and economic consequence.

Objective: Based on the findings from subjective assessment and physical examination, the objective of the current study focused on early physiotherapy intervention measures for preventing complications such as contracture, joint stiffness, muscle wasting, severe gait abnormality, vertebral mal-alignment, and unusual pain.

Case Description: A 4-month-old patient referred for physiotherapy evaluation following an inability to functionally move the two lower limbs and lifting of the left upper limb. There was no history of previous treatment before referral to physiotherapy management. The physical therapists reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use an approach combining the use of low intensity, short duration, and intermittent activity or exercise performed within patient’s limit of fatigue, weakness, and pain.

Intervention: The child was on low-intensity exercises, electrical muscle stimulation and heat therapy 3 times per week for 12 months, 2 times per week for12 months, once a week, and once in two weeks for 6 months.

Outcomes:  Patient was able to achieve one-minute ambulation without walking aid in 33 months. Significantly, patient attained 5-minute ambulation in 36 months’ time. Also, ranges of motion were intact with no records of contracture in any tendon.

Discussion: The outcome of this study demonstrated that early physiotherapy intervention and long-term follow-up are beneficial in preventing/reducing complications, thereby regaining of millstones and achieving functional independence in patients with acute flaccid paralysis such as polio.

Open Access Case Study

Diabetes Keto-acidosis in Children: A Report of Two Cases and Literature Review

B. G. Mande, A. S. Batina, O. J. Alworonga, D. N. Ngbonda

Asian Journal of Pediatric Research, Page 1-5
DOI: 10.9734/ajpr/2019/v2i130098

Aims: To present features of two cases of diabetes keto-acidosis observed in the Nouveau Village de Pédiatrie, Democratic Republic of Congo (DRC), between 2014 and 2018.

Cases Presentation: The first case was a male patient, 13 years-old, who arrived with fever, vomiting, polyuria, unconsciousness, respiratory distress and coma. His fasting plasma glucose was 570 mg/dl. Urea nitrogen 56,4 mg/dl; Creatinine 2,1 mg/dl. C reactive protein was 27 mg/l. The treatment of diabetes ketoacidosis (DKA) was based on insulin, fluids and antibiotics. Despite glycemic normalization, he died with cerebral edema and sepsis. The second case was a female child of 6 years, received with fever, polydipsia, asthenia, polyuria, a familial history of diabetes. Random plasma glucose was 500 mg/dl and C reactive protein 10 mg/l. Despite insulin and antibiotics, her clinical state worsened by a pyelonephritis and pulmonary edema and, probably tuberculosis. She also died.

Conclusion: Diabetes mellitus type 1 in children, complicated with DKA and sepsis, have worse prognosis. More children death would be avoidable by correct global treatment including insulin and hydro-electrolytic balance to prevent cerebral or pulmonary edema. Children with tuberculosis should realize routine screening for diabetes mellitus and inversely.

Open Access Original Research Article

Prelacteal Feeding Practices of Mothers Attending Infant Welfare Clinic in a Tertiary Hospital in Port Harcourt, Nigeria

P. I. Opara, B. A. Alex-Hart

Asian Journal of Pediatric Research, Page 1-8
DOI: 10.9734/ajpr/2019/v2i130096

Background: Breastfeeding pattern established in the immediate neonatal period is a determinant of long term breastfeeding behaviour.

Objectives: To determine prelacteal feeding practices of mothers attending the Infant Welfare Clinic of a tertiary hospital in Port Harcourt, Nigeria.

Subjects and Methods: This was a cross sectional hospital based study carried out over a 3 month period. A structured, self-administered questionnaire was distributed to mothers whose babies were 0 to 6 months old, who visited the infant welfare clinics of the hospital for any of the child health services such as immunization, nutrition counselling, weighing and vitamin A supplementation. Questions asked included socio-demographics, the first feeds given immediately after birth, how long it took to commence breastfeeding and reasons for giving any feeds other than breast milk.

Results: A total of 207 mothers participated in this study, mean age 30.73±4.129SD. 146 (70.5%) mothers gave breast milk as the first feeds to their babies while 61(29.5%) gave prelacteal feeds. Fifty eight (28%) of the babies were put to breast within 2-12 hours after delivery. There was a significant positive relationship between time to first breast feed and administration of prelacteal feeds (p = 0.000).

Reasons for giving substances other than breast milk included poor or no lactation and caesarian section delivery. The commonest reason for not giving breast milk as the first feed was because breast milk did not flow. Factors which positively influenced giving breastmilk as the first feed included maternal level of education (p=0.018), delivery in government health facilities (p=0.00) and having vaginal delivery (p=0.008). 

Conclusion: Prelacteal feeding practice is common among mothers in Port Harcourt. Time to first breast feed, mode of delivery and place of delivery were some of the factors that influenced use of prelacteal feeds.

Open Access Original Research Article

Management of Paediatric Pain: Knowledge and Practice of Healthcare Providers at a Tertiary Centre, Southern Nigeria

G. K. Eke, D. C. Briggs

Asian Journal of Pediatric Research, Page 1-8
DOI: 10.9734/ajpr/2019/v2i130097

Background: Many disease processes and interventional procedures in paediatrics are associated with pain. In spite of its frequency, it is undertreated globally, exposing children to the risks of long-term physical and psychological sequelae, which can have adverse effects on future treatments.

Objectives: To ascertain the knowledge, attitude and practice of healthcare providers towards management of paediatric pain at the University of Port Harcourt Teaching Hospital.

Methods: In this cross-sectional survey, a semi-structured and self-administered questionnaire was distributed amongst a convenient sample of physicians and nurses attached to clinical departments/units where children are cared for, and those in educational units, between June and August 2017. Their knowledge and attitude toward pain management were analysed using Epi Info v7 software (CDC, USA).

Results: One hundred and ninety seven subjects participated in the study, 95(48.2%) physicians and 102(51.8%) nurses, all of various cadres. Seventy-four percent of them had more than 5 years working experience. One third of participants (30.4%) could name up to 3 non-pharmacological methods of pain management, of which the commonest were cold compress (48(24.4%) with nurses>physicians), followed by hot compress (38(19%)) and distraction (24(12%)). The commonest procedures for which non-pharmacological interventions of pain management were usually applied included immunisation of infants (20%) and venepuncture (17%) while lumbar puncture was the least (1.5%). Half of respondents (52%) had never prescribed/administered morphine to children.

Conclusion: Healthcare providers had poor knowledge of paediatric pain management. There is an urgent need to build their capacity to enable optimal relief of pain among paediatric patients.

Open Access Original Research Article

Level of Knowledge on Prematurity and Its Complications in Women Seeking Care at Referral Hospitals in Mexico

José Alfonso Gutiérrez-Padilla, Julio César Monge-Diaz, Alejandro Osorio-Euan, Karen Jacqueline Pacheco-Chi, Juan Carlos Barrera-de Leon

Asian Journal of Pediatric Research, Page 1-10
DOI: 10.9734/ajpr/2019/v2i130099

Objective: To determine the level of knowledge that women had on risk factors for and complications of prematurity at a referral hospital.

Materials and Methods: This was a comparative transverse study conducted in 2015, including women seeking care at a referral hospital, dividing this population into four groups: 1. Pregnant, n=108 (37%), 2. Not pregnant, n=85 (29%), 3. Women seeking an ophthalmological appointment for their prematurely born infant, n=13 (5%), and 4. Women with babies in Neonatal Intensive Care Units, n=85 (29%). Inferential statistics with chi-squared and Mann–Whitney U tests were applied using SPSS ver. 21.0 statistical software package.

Results: The population of women in its majority lived in a common-law marriage and had a secondary-school education. Knowledge of neonatal risk factors included smoking, n=239 (82%) alcoholism, n=236 (81%) diabetes, n=176 (61%), hypertension, n=210 (72%), and fever, n=123 (42%). Significant differences among this study groups were found in relation to the following risk factors for and complication of prematurity; alcoholism, p=0.001; diabetes, p=0.012; the infant’s eye problems, p=0.004; the infant’s language problems, p=0.036, and retinopathy of the premature infant, p=0.027. Differences were found on comparing adolescent with older mothers in terms of knowledge of risk factors, p=0.000 and knowledge of long-term prematurity complications, p=0.005.

Conclusion: The principal risk factors identified by mothers were smoking, alcoholism, and diabetes. The most frequently referred complications in the prematurely born infant were those that presented at the short term, mainly ocular and language problem complications.