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Background: Although the official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports some anecdotal, of survival of babies delivered at younger gestational age (GA) from different parts of the country. The routine resuscitation and management of premature infants born before the official age of fetal viability (28 weeks) is likely to generate important ethical and medical concerns that are bound to influence our approach to the management of such infants. Aim: To determine the GA- specific neonatal mortality and survival among preterm deliveries at the National Hospital Abuja. Subjects and Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database based on the Research Electronic Data Capture software (REDCap) was undertaken to determine the mortality rate of preterm babies managed in the neonatal intensive care unit (NICU) from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. Gestational age estimation was based on mothers’ last menstrual period (LMP) in over 96% of cases. Results: Sixty-three (63) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.7%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal corticosteroid use was low (11.2%), 188 (25.8%) received CPAP for Respiratory Distress Syndrome (RDS), and none of the babies received surfactant or mechanical ventilation. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However, the survival rate at 26 weeks gestation was 53.8%, and this subsequently increased, reaching a peak of 96.5% survival at 35 weeks. RDS accounted for 53.9% of all deaths. Conclusion: It is concluded that the survival rate (53.8%) of babies at GA of 26 weeks despite minimal antenatal interventions and limited postnatal respiratory support was reasonably high, and this could serve the basis for discussions for a downward review of the age of fetal viability in Nigeria.

Background: Under nutrition and overweight in children co-exist in developing countries and may persist into adulthood. Interpretation of body mass index (BMI), a useful measure of nutritional status in children requires age related reference standards, many of which were developed from different international sources. It is necessary to determine which of these reference standards is most suitable for use in the assessment of BMI distribution among adolescents in Nigeria. Objective: To determine the prevalence of thinness, overweight and obesity using the World Health Organization (WHO), International Obesity Task Force (IOTF), and Centre for Disease Control (CDC) reference standards and assess their level of agreement amongst adolescents in Sokoto metropolis. Methods: 800 students were selected through multi-stage sampling technique from secondary schools. BMI was classified according to three reference standards (WHO, CDC, IOTF). Data was analysed with SPSS version 22. The level of agreement between the reference standards in diagnosing nutritional status was assessed using Kappa statistics. Level of significance was put at p< 0.05. Results: The prevalence rate of thinness was highest with the IOTF at 22.6% compared to 19.4%, and 19.6% by the WHO and CDC respectively. The prevalence rates of overweight and obesity were highest with the WHO reference standards at 7.0% and 1.3% followed by the IOTF (6.1%and 0.6%) and lowest with the CDC (5.8% and 0.3%). Substantial agreement was observed between WHO and IOTF (Kappa = 0.77), while the level of agreement was 0.68 for IOTF/CDC and 0.64 for WHO/CDC. All agreement statistics were significant (p < 0.001). Conclusion: The WHO and IOTF reference charts may be more suitable for our population.

The 10th Annual General and Scientific Meeting (AGSM) of the Nigerian Society of Neonatal Medicine (NISONM) took place in Ibadan, South-West Nigeria. The theme of the conference was: Imperatives in neonatal survival initiatives in Nigeria: The current state. The conference addressed a variety of topics relevant to newborn health from eminent speakers from across the globe. The four-day conference included preconference workshops and community mobilization/ health outreach in Lagelu local government area.

Objective: To determine the rate of mother to child transmission of HIV following the introduction of PMTCT program in Abuja. Method: A prospective study of 355 seropositive mothers and their newborns was conducted at the National Hospital Abuja and Asokoro District Hospital Abuja over a 12 months’ period following ethical approval. Using DNA PCR the HIV status of all the exposed babies delivered over the period was determined by taking their peripheral blood at 6 weeks of age. This was repeated 6 weeks post cessation of breast feeding for breastfed babies.. Furthermore, the babies were categorized based on the extent of participation of their mothers in the PMTCT programme and the transmission rates obtained were compared. Result: An overall HIV vertical transmission rate of 6.4% (23/359) was found. A lower rate of 1.6%(5/311) was obtained for those whose mothers fully accessed PMTCT programme as opposed to 15.0% (3/20) for those whose mothers had incomplete participation and 53.6%(15/28) for those whose mothers did not participate. Conclusion: Full participation in PMTCT programme significantly reduced mother to child transmission of HIV.

Background: Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. It was hypothesized that applying the principle of under-water-seal pressure generation could convert a simple oxygen delivery system into an effective Bubble CPAP device. Objectives: To provide evidence in support of the immediate clinical effectiveness of the NHBCPAP device. Design/Methods: At the neonatal unit of the National Hospital Abuja, we assembled a circuit of tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-waterseal bottle to generate CPAP. The device is activated by turning on the oxygen source. The device was applied to preterm babies with RDS as well as some term babies with respiratory distress admitted into the neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were monitored before and at 1 hour, 6 hours and 12 hours after the application. Results: Forty eight newborn babies with respiratory distress were treated with the device out of whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6 (10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p

Summary Background: Neural tube defect is the most common congenital abnormality of the central nervous system. Objectives: 'To document the clinical patterns and neonatal outcome of babies with open neural tube defects at the National Hospital, Abuja.. Design: Retrospective review. Patients: All babies admitted into the Newborn Unit of the hospital with a diagnosis of open neural tube defect between July 2000 and June 2003. Methods: Case notes were retrieved and relevant information was extracted for analysis. Results: Eighteen babies (13 males, five females) presented with open neural tube defects of which 16 (88.9 percent) were outborn. Although 14 of the mothers received routine antenatal care, only eight of them took folic acid regularly. Prenatal diagnosis was made in one of five mothers who had antenatal abdominal ultrasound. The predominant clinical type was lumbosac ral myelomeningocele (61.1 percent). Six (33.3 percent) babies had hydrocephalus at presenta tion, while three of the babies with encephalocele were microcephalic. Vaginal deliverywas asso ciated with an increased risk of ruptured myelocele sac. Limb paralysis and sphincteric dysfunc tion occurred in eight (44.4 percent) of the babies. The defects were repaired at a mean age of 7.8+ 3.1 days in five patients, while three babies died (anencephaly-1, ruptured sac with menin gitis = 2), resulting in a mortality rate of 16.7 percent. Conclusion: We suggest that efforts be intensified to diagnose these lesions antenatally, in order to allow for prenatal counseling, planned cautious delivery and prompt multidisciplinary postna tal management, as these would most likely result in improved neonatal outcome.

Symptomatic subdural haematoma (SDH) in term infants typically occur following traumatic vaginal delivery. Emergency Caesarean Section (EmC/S) carried out after failed attempts at vaginal delivery may also be complicated by symptomatic SDH but spontaneous symptomatic SDH complicating Elective Caesarean Section (ElC/S) is a rarity. We describe a case of massive SDH in a term baby delivered by Elective C/S in the absence of risk factors for intracranial haemorrhage. The aim of this presentation is to highlight the significance of acute subdural haematoma in the diagnostic work up of neonates presenting with acute neurologic symptoms in the absence of traumatic delivery.

Hypomelanosis of Ito (HI) though said to be the thirdmost common neurocutaneus disorder, is rarely reported in paediatric practice in Africa. A high index of suspicion must be maintained in children with cutaneous lesions as a seizure may be the first symptom that may bring the child to attention. A case of HI in a neonate is hereby reported to sensitize clinicians about this relatively uncommon disorder

We report prune belly syndrome, a rare congenital malformation, in a set of twins delivered to a young couple with a history of three previous first trimester spontaneous abortions, discordant HIV seropositivity and antenatal ultrasound report that indicated renal abnormalities in only one of the twins. The challenges of management are discussed.

Using the principle of under-water-seal pressure, we assembled a circuit to produce an effective Bubble Continuous Positive Airway Pressure device at the National Hospital. The device is reasonably inexpensive and is suitable for use at secondary and tertiary health institutions for the care of the preterm infant with RDS.

Abstract This study examines the SENSE-TRI program’s effectiveness in improving the fundamental literacy skills of grade 3 learners in insurgency-challenged Gombe and Adamawa states of Nigeria during the COVID-19 lockdown. A quasi-experimental design was employed, with 400 participants equally divided between randomly selected schools and pupils from SENSE intervention schools (the treatment group) and a counterfactual group from schools and pupils not participating in the SENSE-TRI program (the comparison group). The learners’ performance in both groups was assessed by the abbreviated Early Grade Reading Assessment (EGRA), focusing on tasks such as letter-sound identification, syllable sound identification, familiar word reading, invented word reading, and reading comprehension. The TRI program compared learners’ scores in the treatment group with those of learners in the comparison group using Tobit regression models. The results revealed that sociodemographic variables had no significant independent influence on the observed outcomes. However, the scores showed a statistically significant improvement in the literacy abilities of the treatment group on all parameters and tasks compared to the control group. This improvement exceeded the initial SENSE baseline reading proficiency aggregate values, indicating the program’s effectiveness in both challenging and normal circumstances as a possible way out when no schools exist.

Government leadership is key to enhancing maternal and newborn survival. In low/middle-income countries, donor support is extensive and multiple actors add complexity. For policymakers and others interested in harmonising diverse maternal and newborn health efforts, a coherent description of project components and their intended outcomes, based on a common theory of change, can be a valuable tool. We outline an approach to developing such a tool to describe the work and the intended effect of a portfolio of nine large-scale maternal and newborn health projects in north-east Nigeria, Ethiopia and Uttar Pradesh in India. Teams from these projects developed a framework, the ‘characterisation framework’, based on a common theory of change. They used this framework to describe their innovations and their intended outcomes. Individual project characterisations were then collated in each geography, to identify what innovations were implemented where, when and at what scale, as well as the expected health benefit of the joint efforts of all projects. Our study had some limitations. It would have been enhanced by a more detailed description and analysis of context and, by framing our work in terms of discrete innovations, we may have missed some synergistic aspects of the combination of those innovations. Our approach can be valuable for building a programme according to a commonly agreed theory of change, as well as for researchers examining the effectiveness of the combined work of a range of actors. The exercise enables policymakers and funders, both within and between countries, to enhance coordination of efforts and to inform decision-making about what to fund, when and where.

Background: Anterior fontanelles (AFs) of healthy newborn infants vary widely in size, this being a function of race, geographical location, gender, birth weight, mode of delivery and gestation. Abnormal variations in AF size portend a serious pathology of the cranium or intracranial structures. The established reference value for normal AF size is, therefore, an essential diagnostic tool. This study was conducted to determine the mean AF size and factors that are associated with its variability among apparently healthy term neonates in Lokoja, North Central Nigeria., Methods: AF size was measured in 200 healthy inborn term neonates between 24 and 48 h post-delivery using a modified version of Mattur's method. Other parameters measured were head circumference, birth weight and length. Relevant statistical methods were used for data analysis, and P < 0.05 at a confidence interval of 95% was considered statistically significant., Results: Eighty-six (43%) of the babies were males, and the mean birth weight and gestation were 3.09 (0.37) kg and 38.8 (1.2) weeks, respectively. Majority (72%) were delivered spontaneously per vagina. The mean (± SD) AF size of the study neonates was 2.62 (0.72) cm (2.53 [0.61] cm in males and 2.69 [0.79] cm in females). Neither gender nor mode of delivery affected AF size significantly. There was no significant correlation between AF size and occipitofrontal circumference., Conclusion: AF size for term babies in our hospital differs from AF sizes reported from other parts of the world, further reiterating the utility of local/regional neonatal AF reference values., (Copyright © 2024 Copyright: © 2024 Nigerian Postgraduate Medical Journal.)

Aim: We aimed to describe in-hospital mortality, and its predictors, in very low birthweight (VLBW) infants managed in tertiary centres in a low- to middle-income country., Methods: This was a retrospective cohort study of VLBW infants (birthweight 500 to 1500 grams) admitted within 72 h of life to the neonatal intensive care units (NICUs) of three tertiary centres in Nigeria from July 2017 to March 2021. We describe in-hospital mortality rates, causes and when they died. The independent predictors of in-hospital mortality were determined using multivariate logistic analysis., Results: Of the 6187 NICU admissions, 1161 met the inclusion criteria: 545 (47%) VLBW infants died, including 309 (57%) from respiratory distress syndrome, and 55% occurred within 72 h of life. The adjusted odds (aOR) for mortality increased with each extra Downes respiratory distress score (aOR 1.27) with a 95% confidence interval (CI) of 1.14-1.41. Study site 3 had a higher aOR for mortality than site 1 (aOR 2.78, 95% CI 1.72-4.48) and site 2 (aOR 2.29, 95% CI 1.45-3.61)., Conclusion: Nearly half (47%) of all VLBW infants admitted to three tertiary referral hospitals in Nigeria died during hospitalisation. Mortality varied significantly by site and both the centre and respiratory distress independently predicted mortality., (© 2022 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm., Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses., Materials and Methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds., Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000)., Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial., Competing Interests: None

Background: The brain in the early adolescent period undergoes enhanced changes with the radical reorganisation of the neuronal network leading to improvement in cognitive capacity. A complex interplay exists between environment and genetics that influences the outcome of intellectual capability. We, therefore, aimed to evaluate the relationship between socio-demographic variables and measures of cognitive function (intelligence quotient [IQ] and academic performance) of early adolescents., Methods: The study was a descriptive cross-sectional study of early adolescents aged 10-14 years. Raven's Standard Progressive Matrices was used to assess the IQ and academic performance was assessed by obtaining the average of all the subjects' scores in the last three terms that made up an academic year. A confidence interval of 95% was assumed and a value of P < 0.05 was considered statistically significant., Results: The overall mean (standard deviation) age of the study population was 11.1 years (±1.3) with male-to-female ratio of 1:1. Female sex was associated with better academic performance with P = 0.004. The students with optimal IQ performance were more likely (61.7%) to perform above average than those with sub-optimal IQ performance (28.6%). As the mother's age increased, the likelihood of having optimal IQ performance increased 1.04 times (odds ratio [OR] = 1.04; 95 confidence interval [CI] = 1.01-1.07). Students in private schools were three times more likely to have optimal IQ performance than those from public schools (OR = 2.79; 95 CI = 1.65-4.71)., Conclusion: The present study demonstrated that students' IQ performance and the female gender were associated with above-average academic performance. The predictors of optimal IQ performance found in this study were students' age, maternal age and school type., Competing Interests: None

Background: The current neonatal mortality rate in Nigeria (37/1000) is among the highest in the world and the major causes have consistently been reported as sepsis, perinatal asphyxia and prematurity. However, case-specific fatality which defines the risk of dying from these and other neonatal morbidities is rarely emphasized. Determination of case-specific fatality rates (CSFR) may inform a change in our current approach to neonatal care interventions which may eventually bring about the much-needed reduction in our neonatal mortality rate. Our aim was to determine the case-specific fatality rates for the common causes of mortality among hospitalized neonates at the National Hospital Abuja (NHA)., Methods: Relevant demographic and clinical data on all neonates admitted into the NICU at the NHA over a period of 13 months (January 2017 to February 2018) were extracted from the Neonatal Registry database and analyzed using appropriate statistical methods with the SPSS version 20 software. The case-specific fatality rates were computed for the predominant morbidities in addition to determination of the neonatal mortality rates and associated risk factors., Results and Conclusion: A total of 730 neonates were admitted, out of which 391 (53.6%) were females, 396 (54.5%) were inborn and 396 (54.2%) were term. The three most prevalent morbidities were prematurity 272(37.2%), neonatal Jaundice 208(28.4%) and perinatal asphyxia 91(12.5%) while the most common causes of mortality were prematurity 47/113(41.6%), congenital malformations 27/113(23.9%) and perinatal asphyxia 26/113(23%). Congenital malformations had the highest case-specific fatality 27/83(32.5%) followed by Perinatal Asphyxia 26/91(28.6%) and prematurity 47/272(20.7%). The mortality pattern differed between inborn and out born babies. Implications of these case-specific fatality rates for targeted interventions are discussed.

Aplasia cutis congenita is a rare congenital abnormality first described in 1767 by cordon. It mostly appears as a solitary lesion involving various layers of the skin and sometimes the bone on the scalp, limbs or abdomen. Genetics, environmental and exogenous causes have been implicated as potential causes. Only about 500 cases have been reported globally as of 2013. Two cases of Aplasia Cutis Congenita (ACC) who presented with scalp and bone defects at birth are reported, one in a syndromic child delivered to a consanguineous family, with associated cardiac, skin and nail anomalies (likely Adams Oliver syndrome) and the other as an isolated scalp lesion. Both were large defects managed conservatively by a multidisciplinary team. The challenges of investigating and managing such complex scalp anomalies in sub-Saharan Africa are highlighted., Competing Interests: The authors declare no competing interests., (Copyright: Mariya Mukhtar-Yola et al.)

Background: Haemoglobin (Hb) disorders are among the most common blood genetic disorders worldwide, and they constitute an important cause of morbidity and mortality, especially in Nigeria. Despite the clinical significance of early diagnosis, newborn screening for these conditions is not routinely done in Nigeria., Objective: This study was undertaken to document the pattern of Hb phenotypes of newborn babies at the National Hospital Abuja and highlight the relevance of neonatal screening for early diagnosis of abnormal Hb phenotypes in Nigeria., Subjects and Methods: A prospective study of eligible newborn babies delivered in the hospital at the study site was undertaken following parental informed consent. Venous blood was collected from the babies into an ethylenediaminetetraacetic acid sample bottles. The samples were analysed using high-performance liquid chromatography (HPLC) techniques, and the Hb phenotypes obtained were documented. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM-SPSS, Armonk, NY, USA)., Results: Three hundred and eleven newborns (male = 173, female = 138) aged 0-28 days were recruited. Two hundred and thirty-six (75.9%) babies had Hb AA (FA) phenotype, 63 (20.3%) Hb AS (FAS), 6 (1.9%) Hb SS (FS), 4 (1.3%) Hb AC (FAC) and 2 (0.6%) had abnormal HbA variants. The overall prevalence of abnormal Hb phenotype was 24.1%. The results showed a significant association of sex (P = 0.003) and ethnicity (P = 0.047) with Hb phenotype., Conclusion: There is a wide spectrum of abnormal Hb phenotypes in Nigeria, and these phenotypes can easily be detected at birth using HPLC. We, therefore, recommend routine neonatal screening for sickle cell disease by HPLC in Nigeria., Competing Interests: None

The neonatal period is a critical time for survival of the child. A disproportionate amount of neonatal deaths occur in low-resource countries and are attributable to perinatal events, especially birth asphyxia. This project aimed to reduce the incidence of birth asphyxia by 20% by June 2014 through training in neonatal resuscitation and improving the availability of resuscitation equipment in the delivery room in the National Hospital Abuja, Nigeria. A prospective, longitudinal study using statistical process control analytical methods was done enrolling babies delivered at the National Hospital Abuja. Low Apgar scores or birth asphyxia (defined a priori as any score <7 at 1, 5 and/or at 10 min) was assessed. To ensure reliability and validity of Apgar scoring, trainings on scoring were held for labour and delivery staff. Interventions included provision of additional equipment and trainings on neonatal resuscitation. Apgar scores were aggregated weekly over 25 months. Control charts with three SE confidence limits were used to monitor the proportion of scores ≤7. The baseline incidence of low Apgar scores, as defined a priori, was 33%, 17% and 10% while postintervention the incidence was 18%, 17% and 6% at 1, 5 and 10 min, respectively-a reduction of 45% and 40% in the 1-min and 10-min low Apgar scores. Increased communication, additional resuscitation equipment and training of delivery personnel on neonatal resuscitation are associated with reductions in measures of birth asphyxia. These improvements have been sustained and efforts are ongoing to spread our interventions to other special care delivery units/nursery in adjoining states. Our study demonstrates the feasibility and utility of using improvement science methods to assess and improve perinatal outcome in low-resource settings., Competing Interests: Competing interests: None declared.

Background: Ninety percentage of children acquire human immunodeficiency virus (HIV) infection in the form of Mother-to-child Transmission (MTCT). In the absence of interventions, transmission rates range from 15% to 45%. This can be reduced to below 5% with effective interventions. The last published national guideline (NG) on prevention of MTCT (PMTCT) was in 2010. Clinical audits are essential in improving the quality of care delivered to patients., Objectives: The study objectives were to determine the rate of MTCT of HIV in exposed infants at a follow-up clinic between 2011 and 2014 and to determine the level of adherence to 2010 NG on the use of highly active antiretroviral therapy (HAART), polymerase chain reaction (PCR) testing, feeding options, antiretroviral (ARV) prophylaxis and the use of co-trimoxazole (CTZ)., Methods: A retrospective review of data was done over 4 years. The population consisted of babies delivered through PMTCT programme and those referred to the clinic from other centres. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21., Results: Out of 699 babies enrolled, MTCT occurred in 22 babies (3.2%) and PCR testing was done in 445 babies (64.7%), most in the 1-2 months' age group. Breastfeeding was practiced in 402 (58.2%) babies, while about 88.0% of them received post-exposure ARV prophylaxis (PEP). CTZ prophylaxis was offered to only 226 (34.6%) babies. The regression model showed that maternal use of HAART and PEP for babies was independently associated with a reduction in transmission rate., Conclusion: The MTCT rate was 3.2%. There is a need to strengthen service provision to adhere to NG, especially on breastfeeding and CTZ prophylaxis., Competing Interests: There are no conflicts of interest

Objectives: Because few studies have been conducted on group B Streptococcus (GBS) in Nigeria, we sought to estimate GBS colonization and transmission frequencies for 500 women and their newborns and identify risk factors for both outcomes., Methods: GBS strains were characterized for antibiotic susceptibilities, capsule (cps) genotype, pilus island profile and multilocus sequence type (ST)., Results: In all, 171 (34.2%) mothers and 95 (19.0%) of their newborns were colonized with GBS; the vertical transmission rate was 48.5%. One newborn developed early-onset disease, yielding an incidence of 2.0 cases per 1000 live births (95% CI 0.50-7.30). Rectal maternal colonization (OR 26.6; 95% CI 13.69-51.58) and prolonged rupture of membranes (OR 4.2; 95% CI 1.03-17.17) were associated with neonatal colonization, whereas prolonged membrane rupture (OR 3.4; 95% CI 1.04-11.39) and young maternal age (OR 2.0; 95% CI 1.22-3.39) were associated with maternal colonization. Women reporting four or more intrapartum vaginal examinations (OR 6.1; 95% CI 3.41-10.93) and douching (OR 3.7; 95% CI 2.26-6.11) were also more likely to be colonized. Twelve STs were identified among 35 mother-baby pairs with evidence of transmission; strains of cpsV ST-19 (n = 9; 25.7%) and cpsIII ST-182 (n = 7; 20.0%) predominated., Conclusions: These data demonstrate high rates of colonization and transmission in a population that does not use antibiotics to prevent neonatal infections, a strategy that should be considered in the future., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja., Methods: Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500-3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births., Results: The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia., Conclusion: Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.

Anaemia is a common morbidity in the NICU and often requires transfusion of packed red blood cells. Haematocrit equilibration following red cell transfusion occurs over time ultimately resulting in a stable packed cell volume (PCV). Knowledge of this equilibration process is pertinent in the accurate timing of posttransfusion (PT) PCV. We conducted a prospective study to determine an appropriate timing for PT PCV estimation on 47 stable anaemic babies at the Neonatal Unit of National Hospital, Abuja. Values of PCV were determined before transfusion and at 1, 6, 12, 24, and 48 hours posttransfusion. Forty of the recruited neonates and young infants were analyzed. Their gestational age range was 26 to 40 weeks. 1-hour PT PCV (48.5% ± 5.5%) was similar to the 6-hour PT PCV (47.8% ± 5.6%) P = 0.516, but both were significantly different from the 12-hour (46.8% ± 5.9%), 24-hour (45.9 ± 5.8%), and 48-hour (45.4% ± 6.2%) PT PCVs. The 12-hour PT PCV was similar to the 24-hour and 48-hour PT PCVs (P = 0.237 and 0.063, resp.). We concluded that, in stable nonhaemorrhaging and nonhaemolysing young infants, the estimated timing of haematocrit equilibration and, consequently, posttransfusion PCV is 12 hours after red blood cell transfusion.

Background: In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means., Methods: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed., Results: Sixty (50.4%) of 119 children ingested "My pikin" teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management., Conclusions: Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.

There is no certainty about the best way of dealing with a breech presentation first diagnosed in labour. In our unit, the decision to allow a trial of vaginal delivery rested on the clinical assessment of the size of the baby and the maternal pelvis, and the progress of labour. We compared the outcome of 32 cases where a breech presentation was first diagnosed in labour with 65 women where the malpresentation was diagnosed antenatally where a full assessment including ultrasound and radiological pelvimetry could be made. There was no significant difference in the mode of delivery and fetal outcome. We continue to favour careful case selection for vaginal delivery even where the breech is first diagnosed in labour.

Clinical data obtained prospectively from 98 neonates, 49 normal weight controls, and retrospectively from their mothers had revealed a low incidence of neonatal macrosomia and some important predictive indices of conception and safe delivery of such babies. All the macrosomic infants were singletons and above 37 weeks gestation. The incidence of macrosomia was 26 per 1,000 live births. Increasing maternal age (up to 28 years) parity (up to three) and height were positively correlated with the conception and safe delivery of a macrosomic baby. A maternal height of less than 1.64m was found to be associated with a higher risk of unsafe spontaneous vaginal delivery of a large infant. It is suggested that even in the developing countries all efforts should be made to confirm a diagnosis of foetal macrosomia before the onset of labour so that the mother can be properly assessed for the most appropriate method of delivery.

The sensitivity of Zaria strains of Plasmodium falciparum to chloroquine, mefloquine, quinine and sulphadoxine/pyrimethamine was investigated 5 years after the appearance of in vivo/in vitro chloroquine resistance in urban Zaria. Infections in 36/43 children (83.7%) treated with chloroquine were sensitive while those in 7 (16.3%) were resistant. 8/13 isolates cultured (61.5%) were sensitive in vitro to chloroquine and 5 (38.5%) were resistant. Of the cultured isolates, 13/13 (100%), 12/13 (92.3%) and 5/7 (71.4%) showed mefloquine, quinine and sulphadoxine/pyrimethamine sensitivity, respectively. The results confirmed chloroquine and sulphadoxine/pyrimethamine resistance in urban Zaria and revealed emerging quinine resistance. Resistance to chloroquine and sulphadoxine/pyrimethamine is at RI level and chloroquine should continue to be the first-line drug for the treatment and prevention of P. falciparum infection in the Zaria area of northern Nigeria. We suggest that, while quinine serves as second-line drug, mefloquine should be reserved for infections resistant to chloroquine, quinine and sulphadoxine/pyrimethamine.