South African Journal of Child Health – Vol 17 no 4 - December 2023

Introduction

Low birthweight and maternal smoking as predictors of infant lung function from a South African birth cohort within low socioeconomic communities

The physiological development of infant lungs undergoes dynamic changes in the first few months of life and in early childhood.  Parameters such as tidal volume (TV), respiratory rate (RR) and minute ventilation (MV), which define the functional characteristics of the lungs, change at different scales in relation to lung size.  Measurements of functional residual capacity (FRC) performed in infants have been shown to be significantly associated with lung volume and infant anthropometry (weight and length).  After birth, lung size increases proportionally with body size, and is affected by age and sex.

Prevalence of malnutrition and its impact on outcomes in children with cancer in a South African setting

Malnutrition is defined as ‘a state in which a deficiency (or excess) of energy, protein, and other nutrients causes a measurable adverse effect on the body form and function’ and is a major problem to consider in children with cancer.  Its clinical relevance has been accepted widely by professionals.  In these patients, the cause of malnutrition is multifactorial and includes disease-related or more commonly treatment-related factors.  Chemotherapy may affect nutritional status as a consequence of its side-effects (nausea, vomiting, mucositis and diarrhoea) and there is a strong correlation between malnutrition and intensity of treatment regimens.

The prevalence and spectrum of thyroid dysfunction among children with Down syndrome attending the paediatric services at two tertiary hospitals in Pretoria, South Africa

Down   syndrome (DS) is   the   most   common   chromosomal   abnormality in South Africa and the world at large.  It occurs in approximately 1 in 800 live births worldwide.  In  the  majority  of  cases,  DS  is  due  to  non-disjunction  of  chromosome  21  during  meiosis, and the remainder of the cases are due to translocation or mosaicism.  The diagnosis of DS is made on the clinical findings and on genetic testing karyotype for trisomy. In most developing countries, karyotyping is not feasible for most cases and therefore a clinical diagnosis based on phenotypical features is made, with 88% accuracy.  DS is associated with an increased risk of medical problems.  The most commonly encountered problems in this population include gastro-intestinal, cardiac, haematological, developmental and endocrine abnormalities.

An analytical investigation into noise levels in public health sector neonatal intensive care units in the eThekwini District

This study adopted an analytical observational study design at four public sector hospitals, including one tertiary, and three regional hospitals, in the eThekwini District.  Ethics approval was obtained from the University of KwaZulu-Natal (UKZN) Humanities and Social Sciences Research Ethics Committee (HSSREC) (ref.  no.  HSS/1903/017M).  An SLM (Cel-450 C; Keison, UK) with an A-weighted frequency   weighting and a time-weighting of slow response was used, according to the South African National Standards (SANS 10083:2013). Noise measurements were expressed in LAeq, minimum A-weighted sound level (LAmin), LAmax, and LZpeak. The frequency analysis was conducted using a one-third octave band filter setting to determine intensities in low, mid and high frequencies, which were measured in Hertz (Hz).

The impact of hypothermia in a tertiary hospital neonatal unit

Neonatal hypothermia is defined as a body temperature <36.5°C.  The World Health Organization (WHO) classifies it into three grades of severity:  mild (36.0 - 36.4°C), moderate (32.0 - 35.9°C), and severe (<32.0°C).  The  incidence  of  neonatal  hypothermia  varies widely. The adoption of strategies to prevent hypothermia has led to a decrease in its incidence.  Data from the Vermont Oxford Network showed an improvement in hypothermia on admission of very-low-birthweight (VLBW) infants from 52.6% in 2009, to 38.5% in 2016. However, the incidence remains significantly high in low-resource settings.

The quality of life among children with epilepsy in resource-limited settings: A pilot study in a paediatric neurology clinic at a quaternary care teaching hospital

Health-related quality of life (HRQOL) is a concept which helps practitioners   to   understand   the   social, emotional and physical impact of chronic diseases and to assess healthcare outcome. The  Pediatric  Quality  of  Life  Inventory  4.0  (PedsQL)  generic  core  score  scale  includes  child-self  and  parent-proxy  reports  with  coefficient  of  variation (COV). It has been used as a valid, reliable and feasible gauge for assessment of HRQOL of healthy and chronically ill paediatric populations. However, while the child-self report is the standard tool, parent-proxy reports in clinical practice and medical research are cited as important instruments to evaluate HRQOL of children between 2 and 16 years of age who are unable to complete the questionnaire owing to cognitive impairment, very young age or serious illness.

An audit of electronic discharge summaries of neonates admitted with hypoxic ischaemic encephalopathy to tertiary hospitals in Bloemfontein in 2018 – 2019

A comprehensive discharge summary is an essential part of a patient’s medical record, as emphasised by the Health Professions Council of South Africa (HPCSA). A high-quality summary contains particulars regarding a patient’s most recent hospital admission and is beneficial as the first source of medical information. In resource-limited settings, record-keeping and filing may be suboptimal, particularly for paper-based records.  Electronic medical records may be the only accessible health record to ensure continuity of care.

Borderline hypernatraemia and mortality rates in South African infants: A single-centre observational study

Most   paediatricians   regard   hypernatraemia   as   the   most   severe   electrolyte   abnormality   that   is   associated   with   poor   outcomes   in hospitalised children.  Although there are no clinical studies that   assign   a   definitive   contributory   role   for   hypernatraemia   in   adverse   childhood   outcomes, high mortality (12   -   19%) and morbidity rates (50 - 55%) are reported in children with hypernatraemia. In hospitalised children, hypernatraemia is most commonly detected in infants younger than 1 year of age. However, hypernatraemia is generally uncommon; the best estimates suggest that it is present in 0.4% of hospitalised neonates and 0.04% in hospitalised infants.

Variations in intravenous fluid management for paediatric hypernatraemia in South Africa: A survey of junior and senior South African paediatric doctors

Paediatric hypernatraemia is a severe and life-threatening electrolyte abnormality that occurs as a consequence of inadequate fluid intake, the loss of hypotonic water from diarrhoeal disease, or rarely from excessive sodium intake.  Hypernatraemia occurs in ~10 - 20% of children with dehydrating diarrhoeal disease.  Furthermore, hypernatraemia is associated with high mortality (12 - 19%) and adverse neurodevelopmental outcomes.