Summary: Records of 9,200 infants born with meconium staining of the amniotic fluid in Abha Maternity Hospital, Saudi Arabia, during the period January 1985 to December 1997, were reviewed in order to compare the morbidity and mortality patterns in those receiving oropharyngeal as against those receiving intratracheal suctioning. Of this number, 6,050 (65.8 percent) were intubated for intratracheal suctioning while the remaining 3,150 (34.2 percent) were suctioned down to the oropharynx only. Regardless of the method of suctioning, the incidence of meconium aspiration syndrome (MAS) was the same (7 percent) in both groups. The consistency of the meconium, physical condition of the infant at birth, and whether the pharynx and vocal cords were meconium stained or not, did not appear to influence the frequency of MAS. However, morbidity as determined by the need for prolonged administration of oxygen (48,0 percent vs 79.4 percent) or mechanical ventilation (13.0 percent vs 39.9 percent) was comparatively less among the infants intubated for suctioning in the delivery room. Similarly, the frequency of pneumotho rax (7.8 percent vs 32.6 percent), persistent foetal circulation (5.0 percent vs 18.5 percent) and fatality rate (1.9 percent vs 10.3 percent) were less in those who were intubated. These find ings support the need for routine intubation for intratracheal suctioning in every meconium stained infant regardless of his condition at birth.

Iron deficiency is the most prevalent micronutrient malnutrition globally. It is known to affect both children and adults especially pregnant women largely in the developing countries. Iron is not only important for haemoglobin synthesis but also for normal brain development. In the body, the ferrous formis converted into ferritin which is the active molecule. The brain is especially sensitive to variation in iron availability, in part due to the high metabolic demands of the brain that are supported by iron. Iron is necessary for basic neuronal processes such as myelination, neurotransmitter production, and energy metabolism. With neuroimaging support, Globus pallidus, caudate nucleus, putamen, substantia nigra and the hippocampus have been of primary interest in studies of iron because they show robust and quantifiable levels of iron content. Furthermore, these regions are central to cognitive abilities that develop across childhood and adolescence, such as processing speed, cognitive-motor control, reward-processing, and working memory function. The hippocampus per se plays important roles in the consolidation of information from short-term memory to long- term memory, and in spatial memory that enables navigation. Low iron levels in pregnant women correlates with low ferritin levels in their foetus and newborns whereby several studies have clearly demonstrated the effect of iron on developmental milestone regarding cognition and behaviour. Iron deficiency early in life, therefore, confers irreversible brain dysfunction even after complete brain iron repletion. Iron therapy and replenishment of brain ferritin may revert to normal cognitive functions in adults and adolescents but not in children. Rich sources of iron are meat, liver, dark leafy green vegetables, fish, poultry, peas and beans. Pregnant women require routine daily iron supplement; lactating woman and all children should be fed balanced diet. Special iron supplement should be provided for preterm and small-for-gestational-age infants from the age of two months.

Summary: The case of a three-and-half-year old male child with the severe form of erythema multiforme (EM) major (Stevens-Johnson syn drome) is described. From the past medical history, the child had seven previous attacks of a similar disease in the immediate past 24 months. The first four attacks of the disease were considered, by their description, to be mild EM minor, as the lesions were limited to the skin, while the next four recurrences, including the present one, were regarded as severe, with extensive involvement of the skin, mucosae of the mouth, nose, eyes and urethral orifice, that required hospitalization. Each recurrent episode of the disease was causally related to self-medication with pyrimethamine-sulfadoxine (Fansidar). With the current frequent and indiscrimi nate use of Fansidar and other sulphonamide-containing substances as alternatives for chloroquine-resistant malaria, physicians should be alerted to the possibility of an upsurge in the prevalence and recurrent attacks of EM, minor or major, in malaria-endemic areas of the developing world.

Summary: An outbreak cf measles that occurred among 11 of 16 inmates of an overcrowded motherless babies home in Calabar is presented. The last child, aged eight months, to be admitted into the home, was also the first to develop symptoms of measles, 11 days after admission; thus, it is suggested that this child was incubating the disease before his admission. The patients were aged, between four months and nine years, four patients were below the age of nine months, while six were aged between nine and 18 months; four of these six patients had been immunized against measles. Fifty percent of the 16 inmates were malnourished and of these, 87.5 percent developed measles. Complications of measles consisted mainly of diarrhoea, dehydration and bronchopneumonia. The case fatality was 27.3 percent. It is suggested from the present findings, that immunization of children at the age of six months and perhaps, below, in an environment of poverty and overcrowdiness should be a policy in our immunization schedule.

An epileptic fit does not only manifest as bizarre motor activity but can destabilize autonomic functions. Abnormal electrical discharge originating from the cerebral cortex can spreads to involve the autonomic system thus creating a dysfunction of the sympathetic and the parasympathetic which modulate the cardiorespiratory, digestive, genitourinary systems. The autonomic phenomenon can be encountered in simple partial, complex partial, generalised tonic-clonic, absence and generalized tonic seizures. Both the motor and the autonomic components may manifest simultaneously; at times the autonomic symptoms may precede or outlastthe motor components. Autonomic features affecting the cardiopulmonary function may be life-threatening and contributes to 8-17% of deaths in individuals with epilepsy. Hypoventilation, apnoea, atrial fibrillation, sinus arrhythmias, atrial and ventricular premature depolarisations, bundle branch block and asystole are known to manifest in the peri-ictal and also in interictal phases of epilepsy. Poor control, and polytherapy in the management of patients, render some epileptics more vulnerable toexcessive excitability of the autonomic nervous system. The aim of this communication, therefore, is to alert and remind healthcare givers on the autonomic phenomena of epileptic fits some of which may result in sudden unexpected death. Clinician should always take a holistic approach in the evaluation of epilepsy patients and watch out especially for cardiorespiratory variability during and in-between attacks.

Summary A prospective study was. carried out to determine the prevalent causes and management of congenital stridor in a referral neonatal intensive care unit of Assir Central Hospital, Abha, Saudi Arabia, between 1996 and 1999. Forty cases consisting of 25 males and 15 females were identified during the period. The predominant cause was laryngomalacia in 25 (62.5 per cent) of the cases. Other causes included subglottic stenosis 5 (12.5 per cent), tracheo-oesophageal fistula 3 (7,5 per cent), bilateral vocali cord palsy 2 (5 per cent), vascular compression 2 (5 per cent) and one each of laryngeal web, subglottic haemangioma and cystic hygroma. A majority of the laryngomalacia cases resolved spontaneously by the age of 2 years without surgical intervention.

Objective: To determine the neonatal morbidity and mortality pattern in a cohort of infants bom outside hospital but admitted in Abha Maternity Hospital, Saudi Arabia. Patients and Methods: The charts of 151 women and their infants born at home or en route to the hospital were reviewed and the findings were compared with those of 300 in-hospital (in-bom) deliveries from January 1990 to December 1996. Results: Of the 151 unattended deliveries, 36 percent occurred at home and 64 percent in i motor vehicles. Eighty-three percent of the out-born and 63 percent of the controls had no antenatal care. The incidence of respiratory distress syndrome (RDS) was significantly higher :p=0.002) among the out-born cases. Perinatal mortality among the out-born deliveries was 1.7 percent, in contrast to the 1.0 percent in the in-born group. Conclusion: Despite adequate health facilities and governmental financial support, lack of health education and initiative on the part of the patients might be a major contributing factor to the high level of unattended deliveries with the associated adverse outcome. Inten sive health education with emphasis on the need for antenatal care and on the dangers of dclivering infants outside health facilities is advocated.

Summary: This case report describes reversible hyperglycaemia in a severely ill six-month old Saudi boy treated with nifedipine for hypertension. Hyperglycaemia became manifest on the second day of treatment with nifedipine and was not dose-related. Following discontinuation of the drug, the patient rapidly became euglycaemic. It is concluded that the hyperglycaemia was induced by nifedipine. This side effect of nifedipine has been reported in adults but the present case would appear to be the first of a similar report in a child. We suggest that dehydration due to hyperglycaemia-induced osmotic diuresis can constitute a risk to small infants on nifedipine, hence it should be used with caution on outpatient basis.

Summary: Six children with AIDS, aged between eight and 27 months, are reported. As these patients and their mothers were HIV-positive, the mode of transmisssion was considered to be vertical. In the seventh, well and asymptomatic, but HIV-positive infant, transmission of the infection was through transfusion of contaminated blood that was donated by an HIV-positive father. Of the three fathers screened, two tested positive for HIV. Four of the seven HIV positive infants originated from the Cameroon, while three were resident in Nigeria. The disease manifested within the first four months of life in five patients and at the age of 14 months in one patient. Marasmic features, chronic diarrhoea, pneumonia, generalized lymphadenopathy, oropharyngeal candidiasis and dermatoses were the main clinical features. Management of the patients and the families included symp tomatic treatment and counselling. Four of the patients died, three of these in the hospital and one at home.

Background: Malaria, earlier considered rare in neonates, has been reported with increasing frequency in the last decade. Neonatal malaria diagnosis is challenging because the clinical features are non-specific, variable and also overlap with bacterial infection. Aim: To determine the prevalence of neonatal malaria and the associated clinical features in newborn babies with fever. Patients and methods: One hundred and fifty neonates with fever admitted into the Newborn unit of the University of Calabar Teaching Hospital, over a six month period, were recruited consecutively. Symptoms and signs for each neonate were documented. Blood film for malaria parasites and investigation for sepsis workup were done before commencement of drugs. Results: One hundred and fifty babies were recruited. Most (85.3%) of the babies were aged ≤7 days. One hundred and thirty six (90.7%) of the mothers were booked for antenatal care (ANC). Most of the babies were from primiparous women (54.7%). Six babies (4%) had malaria parasitaemia with four (2.7%) being congenital malaria and two (1.3%) acquired malaria. Plasmodium falciparum was the only species identified. All six with malaria were from the 136 booked mothers. Four of the affected six neonates also had septicaemia. The clinical features in babies with malaria only were, fever, fast breathing and jaundice while those with malaria and bacterial co-infection had, in addition, poor suck. Conclusion: Malaria infection and septicemia can coexist in some Nigerian newborns and since the clinical presentation of each of these condition are closely similar, it is recommend that malaria parasite investigation be included as part of the investigation in the newborns with fever. This approach can help to avoid a delay in applying the appropriate therapeutic intervention

Background: Cranial nerve palsies are common clinical problem routinely encountered in neurological practice; the dysfunction can occur at any point in the course of the nerve and may point to serious pathology. The aim of this study was to determine the pattern and underlying aetiology of cranial nerve palsies in Nigerian children.Method: Children in the Children’s Emergency Unit and the Children’s Ward of the University of Calabar Teaching Hospital, Calabar, Nigeria, with neurological problems over a 12-month period (January through December 2012), were recruited into the study. Each child was admitted and evaluated by the Paediatric Neurology Unit. Those with cranial nerve palsies were selected for detailed analysis. The biodata, clinical features and relevant laboratory results were documented.Results: Of the 285 with neurological problems 23 (8.1%) had cranial nerve palsies. Fifteen (65.2%) of the children had single cranial nerve palsies while eight (34.8%) had multiple cranial nerves involvement. Of the 43 nerves involved, the facial nerve was the commonest (38.3%) followed by the oculomotor (23.5%) and abducens (20.6%). Intracranial infections such as meningitis, viral encephalitis and brain abscess were incriminated in 60.8% of the patients and 70.6% of the nerves involved.Conclusion: Cranial nerve palsies cause handicap and cosmetic problems. It is recommended that every child with cranial neuropathy should be evaluated for intracranial infections among other differentials. Prompt diagnosis, treatment and immunisation against related infections is paramount.

Zinc is essential in the metabolic activities in the body including protein, DNA and RNA synthesis. It plays a role in neurogenesis, maturation, and migration of neurons and in synapse formation. Zinc is high in the hippocampal neurons which is involved in learning and memory. Deficiency of zinc during pregnancy has been related to many congenital abnormalities of the foetal nervous system. Furthermore insufficient levels of zinc in children is associated with lowered learning ability, apathy, lethargy and mental retardation. Maternal deficiency of zinc during lactation has been associated with impairment of infant brain development. Zinc status in mother and child can be assessed by measurement of zinc in plasma; zinc deficiency can be corrected with appropriate diet and zinc supplements. Red meat, poultry items, oysters, cashew nuts and almonds are rich sources of zinc.

Background: Cerebral palsy (CP) is a common disabling condition of movement and posture causing activity limitation arising from a static injury to the developing brain. Common risk factors for cerebral palsy in Africa include severe birth asphyxia, kernicterus and neonatal infections. This study is aimed at determining the aetiology and comorbidities associated with cerebral palsy in our environment.Methods: All children with CP presenting to the Paediatric Neurology clinic of the University of Calabar Teaching Hospital whose parent gave consent were recruited into the study. The biodata of the children and that of the parent’s/ care givers were obtained. A detailed pregnancy and delivery history, neonatal history, seizures during first three years of life and developmental mile stones was documented.Results: Seventy children with CP were recruited into the study of which 46 (65.7%) were males and 24 (34.3%) females. Majority of the children were from low social class and products of home, church or TBA’S delivery where supervision is poor. Severe birth asphyxia and CNS infections are the commonest identified risk factors. Spastic quadriplegic CP is the dominant type of CP followed by spastic hemiplegia. There is a significant statistical relationship between the aetiology and the type of CP. Epilepsy (60%) speech defect (42.9%) and microcephaly (40%) are the predominant comorbidities seen in the study. Cortical atrophy and ventricular dilatation are predominant CT findings in contrast to periventricular leukomalecia seen in developed countries.Conclusions: Majority of the patients with CP in this study are from low social class and were delivered in places with poor obstetrics care. Improved perinatal care through an adequate social support system may reduce the burden of the disease.

Background: Epilepsy is associated with social stigma and discrimination which is often harmful and devastating. Lack of knowledge and misconception is responsible for these negative attitudes. Public awareness and education are known to improve perception towards epileptics.Methods: A sensitization workshop among community leaders on epilepsy was carried out in a rural community in Cross River State, Nigeria. A pretest questionnaire was administered to participants based on items related to knowledge and perception towards epileptics. The respondents were offered a 2-hour workshop on the causes, types, cure and myths about epilepsy. The same questionnaire was again applied after the workshop. The responses before and after intervention were compared using the McNemar test statistic, with a significance level at p<0.05.Results: Seventy-two respondents participated in the study comprising of 42 (58.3%) males and 30 (41.7%) females. Twenty-eight (38.9%) had primary education and the same number had tertiary education. There was a positive correlation between level of education and performances in the perception towards various domains of epilepsy. Statistical significant differences were found in perceptions regarding cure, mode of contracting epilepsy and potentials of epileptics. However, no statistical difference in perception after the intervention regarding marriage to epileptics.Conclusions: Respondents with higher level of education demonstrated significantly better awareness and attitude towards epileptics compared to those with lower levels the intervention package produced a significant improvement in most domains of perception about epilepsy. Public enlightenment is effective in reducing social stigma and discrimination. It should be encouraged to curtail the negative attitude and perception towards epileptics.

Background: The role of caregiving takes on an entirely different significance when a child experiences functional limitations and possible long-term dependence. The main challenges for parents of children with disabilities are their ability to cope with their children's chronic health problems and effectively carry on with daily requirements of everyday living. The aim of this study is to evaluate the challenges parents encounter in caring for children with cerebral palsy in a developing country.Methods: Consenting parents of children with cerebral palsy presenting in the neurology clinic of the University of Calabar Teaching Hospital, Calabar, south-south Nigeria were recruited for the study. The bio data of the parents were obtained. The challenges encountered by parents of children with cerebral palsy were determined using a semi structured questionnaire.Results: Seventy parents of children with cerebral palsy were recruited into the study. Majority of the subjects (61.4%) are from the low socio economic while the least represented was the high socioeconomic class. Sixty-four (91.4%) of the parents worry about the handicap and comorbidities of cerebral palsy. Similarly, 91.4% of parents admitted that their social life has been adversely affected by caring for these children. Also, more than half of the parents find it difficult to cope with their jobs or businesses and have their resources depleted. Family disharmony was found in over 40% of the parents. The task of caring for children with cerebral palsy is a daunting one as its negative impact on family, social and family resources are enormous especially in resource poor countries with little or no social support system. Parents caring for children with disabilities therefore need assistance and respite care to alleviate these challenges, since rehabilitation services are limited in most African countries, it has been suggested that community-based and outreach services are provided in order to decrease the burden of care.Conclusions: Effort should therefore be geared toward prevention. The provision of a social support system and rehabilitation centres at subsidized rates will significantly ease the burden encountered by these parents.

Background: Epilepsies are the most common conditions encountered in most paediatric neurology clinics in many parts of the developing world. In sub-Saharan Africa epilepsies are secondary, reflecting persistently high risks at birth, and the adverse neurological sequelae of CNS infections during and beyond childhood. The study was designed to determine the clinical pattern of childhood epilepsies, probable aetiologies and associated comorbidities of the disease children.Methods: The study was conducted within an 18 months period among children having established epilepsy attending the Neurology Clinic of University of Calabar Teaching Hospital (UCTH). The children and or care givers were interviewed by the authors and the following data were obtained and recorded in a questionnaire; bio data, age at onset of seizure. History was obtained to determine the possible cause of the seizure, type of epilepsy and associated comorbidities. The data obtained was analysed with SPSS version 20. P-value <0.05 was considered significant.Results: Of the one hundred eighty children seen with various neurological morbidities during the study period, one hundred and seven had epilepsy which constitutes 59.4%. Generalized tonic clonic epilepsy was the commonest type of epilepsy found in 66 (61.1%) of the children with epilepsy, followed by simple partial and myoclonic epilepsy in 18.5% and 6.5% respectively. Severe birth asphyxia was responsible was the commonest identifiable cause of epilepsy in 19 (17.8%) of cases while central nervous system infection accounted for 14 (13.1%). Cerebral palsy was the commonest comorbidity in 20 (18.6%) followed by mental retardation in 17 (15.9%) of the children.Conclusions: The study showed epilepsy to be the commonest neurological presentation among children presenting at the paediatric neurology clinic of our facility. Primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen, followed by simple partial seizures. Cerebral palsy and mental retardation were the main associated comorbidities. Birth injuries mainly severe birth asphyxia and CNS infection were the major causes of epilepsy in our study. In conclusion, epilepsy is the commonest neurological morbidity in our environment, limited facilities and resources still militate against identifying the actual aetiology in most children with the disease. Effort should be intensifying to eradicate the preventable causes of the disease.

Children with epilepsy have a significantly higher rate of death than the general population. The cause of premature death among epileptics is contributed by the underlying cause, coexisting neurologic compromise and the epilepsy itself. Mortality directly related to seizures in paediatric epilepsy is the subject of this review. Seizure-related deaths in epileptics arise from status epilepticus, aspiration pneumonia, as well as sudden and unexpected death in epilepsy (SUDEP). Epilepsy per se enhances the risks of accidents and suicide. Children with epilepsy who are otherwise neurologically intact and with normal neuroimaging findings have an exceedingly low risk of seizure-related death. Poor compliance to antiepileptic drugs (AED), poorly controlled (intractable and refractory) seizures, impaired cognition, structural/metabolic aetiology and antiepileptic drug polypharmacy tend to carry poor prognosis. Therefore, parents need to be appropriately advised about the risk of seizurerelated premature death. Early identification, compliance with AED prescription, and treatment of comorbid conditions can reduce mortality risk and improve health outcomes in children with epilepsy. Children with intractable types of epilepsy may benefit from medical marijuana and neurosurgery.

Introduction: Pediatric Human Immunodeficiency Virus (HIV) infection accounts for over 2.3% of all pediatric infections. Many HIV-infected infants are not identified until they develop symptoms and present with illness at health facilities. However, the six weeks immunization visit provides an opportunity for HIV-infected mothers and their exposed infants to be identified before symptoms occur. This study was therefore conducted to determine the HIV status of infants attending immunization clinics in Calabar with a view to enrolling them into treatment. Subjects and Method: This cross sectional descriptive study was conducted in two Local Government Areas of Calabar consisting 22 selected immunization centers. Using the multistage sampling method, 330 infants were screened. Ethical clearance was obtained from the supervising Ministry of Health. Rapid test was conducted, reactive specimens had Deoxyribonucleic Acid Polymerase Chain Reaction (DNA PCR) done using Dried Blood Spots (DBS). Results: A total of 330 infants aged 6 to 14 weeks were recruited, 173 (52.4%) were males while 157(47.6%) were females giving male to female ratio of 1.1:1. Mean age of the infants was 9.20 ± 3.1 weeks. Twenty four (24) tested positive for HIV antibodies, after HIV DNA PCR test, 14(4.2%) infants were infected. Antenatal care registration (ANC) and maternal ANC HIV status were statistically significant P=0.03 and P= 0.02 respectively. Conclusion: HIV exposed and infected infants are still been missed and only diagnosed later in life. Therefore, maternal HIV status determination and early diagnosis at immunization centers is recommended to bridge the Prevention of Mother To child Transmission (PMTCT) gap.

Introduction: The World Health Organization (WHO) estimated that 3.2 million children were living with Human Immunodeficiency Virus (HIV) at the end of 2013, mostly in sub- Saharan Africa. Socio- economic and demographic factors do not only affect viral transmission but also the success of preventive strategies and treatment. Objective: To determine the socio -demographic characteristics of mothers, and the relationship between maternal and HIV status of their infants attending immunization clinics in Calabar. Methods: Using multistage sampling method, 330 subjects were enrolled and screened from 63 immunization centres. The socio- demographic characteristic of each infant’s mother was documented. The results of Rapid test for mothers and Dried Blood Spots (DBS) results for infants were compared. Results: Of the 330 subjects recruited, 173 (52.4%) were males while 157(47.6%) were females. Mean age of the infants was 9.20 ± 3.1 weeks. Twenty four mothers and infants tested positive for HIV antibodies. After confirmatory tests using HIV Deoxyribosenucleic acid (DNA PCR), 14(58.3%) out of 24 antibody seropositive infants were infected. The transmission rate after confirmation was 58.3%. Conclusion: Parental education, social class and low maternal Antiretroviral drug (ARV) use were responsible for transmission. It is therefore recommended that health education on ARV use during antenatal period and HIV status of mother baby pair be done at immunization centres. HIV positive mothers and babies should be promptly referred for therapy.

BACKGROUND:Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis. AIM:To determine the hematological indices in febrile newborn with malaria parasitemia. MATERIALS AND METHODS:One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14. RESULTS:One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization. CONCLUSION:Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.