OBJECTIVES:Preterm delivery abruptly separates a baby from the placental supply of nutrients which are mostly accreted during the third trimester. The study aimed to determine the relationship between plasma levels of vitamin D in mothers and their preterm infants within the first 24 hours of life in a Nigerian population and how this is related to the intrauterine growth pattern. METHODS:This hospital-based panel study of 121 preterm infants and their mothers was carried out in three neonatal units in southwest Nigeria. The plasma levels of vitamin D were assayed in mothers and their corresponding singleton infants while anthropometric parameters of the babies were also recorded. RESULTS:The prevalence of low plasma Vitamin D was 33.1% in the mothers and 43.8% in their preterm neonates. Plasma vitamin D levels in infants showed a moderately strong positive correlation with maternal plasma levels at birth (r = 0.517; p < 0.001). Mean maternal plasma Vitamin D was lowest in mothers whose babies were small for gestational age. CONCLUSION:Notably high proportions of Nigerian preterm infants and their mothers had low plasma Vitamin D around the period of birth and low maternal vitamin D is associated with delivery of small-for-gestational-age babies. Supplementation of Vitamin D in pregnant women and preterm babies is recommended.

Abstracts presented at the 55th Annual Scientific Conference of the Paediatric Association of Nigeria in January 2024 in Lagos, Nigeria.

Although congenital tuberculosis (TB) is rare, it is associated with a high mortality rate. The infection is mainly acquired transplacentally and less frequently from infective lesions on the maternal genital tract. Many cases are missed in clinical practice due to the non-specific presentation of the disease hence the tendency to either miss the diagnosis or make the diagnosis late. We report an infant of a 32-year-old mother who was treated for multi-drug resistant TB before the index pregnancy and probably had a relapse during pregnancy. The infant presented with features of sepsis at the age of ten days, but tuberculosis was only suspected when there was no clinical response to routine antibiotic therapy, and the medical history of the mother was reviewed. This report is to create awareness about the non-specific manifestations of the disease and highlight some helpful diagnostic methods in a resourcepoor setting.

Background: Adequate levels of calcium, phosphate and Vitamin D are essential for bone physiology and growth, as well as preventing some common childhood illnesses. This study aimed to determine the prevalence of the deficiencies of these nutrients and factors affecting their serum levels in Nigerian children. Methods: This was a cross-sectional study that involved 220 apparently healthy children aged 6–24 months in Ikenne Local Government Area of Ogun State, Nigeria. Serum calcium and phosphate were assayed using the calorimetric method, while Vitamin D (25-OH Vitamin D) was assayed with ELISA. Results: The mean (±standard deviation [SD]) serum Vitamin D level was 55.07 ± 16.53 ng/ml, while the mean (±SD) serum calcium and phosphate were 2.27 ± 0.13 mmol/l and 1.28 ± 0.18 mmol/l, respectively. Eleven (5%) of the children had hypovitaminosis D, 23 (10.5%) had hypocalcaemia and 12 (5.5%) had hypophosphataemia. Factors found to be significantly associated with hypovitaminosis D included low consumption of milk and the use of a hijab veil, while malnutrition (both undernutrition and overnutrition) was significantly associated with hypocalcaemia. Conclusion: The prevalence levels of hypovitaminosis D and hypophosphataemia were low, while hypocalcaemia was more common. Low milk consumption and use of a hijab veil were risk factors for hypovitaminosis D, while malnutrition was a risk factor for hypocalcaemia. Malnourished children, especially overnourished ones, should be routinely screened for hypocalcaemia because of its high prevalence among them.

Introduction: given the significant disruption in educational activities during the COVID-19 pandemic and the uncertainties about the post- pandemic future, coupled with increasing demand for the healthcare workforce, e-learning may bridge the gap in training medical students. It was imperative to survey the perception and readiness of the trainers on the use of e-learning for undergraduate medical training in Nigeria. Methods: this cross-sectional study was conducted among teachers of medical students in Nigeria. Using Google Forms, information on sociodemographic details, perception of online medical education, and individual and institutional preparedness to adopt e-learning were obtained. Data analysis was done using SPSS (version 21.0). Results: there were 300 respondents from 25 to 72 years (mean of 47.1 +/- 7.8 years). Most were willing to give core lectures and seminars by e-learning, but only about half (159; 53.0%) had ever delivered any lecture online. Many were against conducting laboratory demonstrations (51%), clinical demonstrations (51.7%), and bedside teachings (54.7%) by e-learning. Few (22.0%) were familiar with assignment management packages. Lack of internet connectivity (69.7%) and poor power supply (69.0%) were the most common barriers to implementing e-learning. There was a significant difference (p < 0.001 for all) in institutional internet provision and accessibility, staff training, and using e-learning for lectures between private and public institutions. Conclusion: utilization of e-learning for medical education is low in Nigeria, with private institutions significantly outperforming the public sector. Many trainers prefer that the practical and clinical aspects should not be integrated into elearning. Government, institutions and trainers need to do more to improve the acceptance and utilization of e-learning.

This Cochrane Review has been withdrawn from publication. Errors were identified in the data extraction process and in the reporting of results, and as such the findings of the review may not be reliable. The authors and the Cochrane Neonatal Co-ordinating Editor agreed to withdraw the review, following an internal investigation. The authors are undertaking a full revision of this Cochrane Review, with the intention of publishing a new version.

BACKGROUND: Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia.METHODS: A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into sub -clinical, primary and secondary hypothyroidism.RESULTS: The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and sub -clinical hypothyroidism was 0%, 0% and 4.2%, respectively.CONCLUSION: Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.

Objectives: To determine the relationship between postnatal foot lengths and estimated gestational age (EGA) in relation to intrauterine growth patterns determined at birth among Nigerian neonates.Design: Hospital-based, cross-sectional.Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.Participants: 260 neonates with EGA 30- 42 weeks within 48 hours of life.Interventions: Postnatal foot lengths (FL) were measured with Vernier digital calliper in millimetres. The intra-uterine growth pattern was determined using the Lubchenco chart. Pearson correlation and regression analysis tests were performed.Main outcome measures: Postnatal foot length in relation to Intra-Uterine Growth PatternResults: The mean postnatal FL had a strong positive correlation with the EGA from 30 through 42 weeks (r = 0.855, p < 0.001). The overall mean foot length for preterm neonates was 65.44 (6.92) mm, while that of term neonates was 77.92 (4.24) mm. The linear regression equation was generated as: EGA = 9.43 + (0.37 × FL), p < 0.001. The EGA as measured by FL had the highest positive correlation with Small for Gestational Age (SGA) intra-uterine-growth pattern, followed by Appropriate for Gestational Age (AGA) and least by Large for Gestational Age (LGA) respectively (r = 0.936> 0.861 > 0.666).Conclusion: The postnatal foot length correlated well with estimated gestational age, and the correlation was best among SGA infants.

Objectives:The current study aimed to determine the proxy measurements for height in children with Cerebral Palsy (CP).Materials & Methods:In a cross-sectional descriptive study, the length/height of Nigerian children with CP was studied over eighteen months using descriptive statistics. The study subjects comprised children aged 15 months to 17 years with CP. Height/length, weight, arm span, forearm length, mid-upper arm circumference, foot length, head circumference, hip circumference, leg length, and tibia length were measured to the nearest 0.1 cm using standard procedures. The relations between segmental measurements and weight with height were investigated using linear regression.Results:A total of 31 children were studied. The correlation between height/length and other linear measurements has a significantly strong positive relationship. Regression analysis showed that when used singly, the weight and thigh length offered a high explanation for the height variability with little estimation error. On the other hand, weight had a lower mean difference between observed and predicted height (0.21 and -0.76, respectively), with thigh length overestimating the height.Conclusion:Weight measurement may be the preferred proxy for height in children with CP.

Most children acquire human immunodeficiency virus (HIV) infection through mother-to-child transmission (MTCT). The risk of MTCT of HIV is generally 15%-40% without prophylaxis. MTCT has been responsible for approximately 370,000 infant HIV infections worldwide, with Nigeria accounting for 30% of cases. The study evaluated the effectiveness of a prevention program for MTCT of HIV infection by determining the rate of MTCT of HIV in infants who underwent the program by reviewing health records of mother infant pairs at the Olabisi Onabanjo University Teaching Hospital. This cross-sectional study conducted over 12 years used medical records of 545 mother infant pairs. The rate of MTCT of HIV infection was 2.9% in this study compared to 7.1% reported by the center earlier. The rate of MTCT of HIV infection was the lowest among mother infant pairs who received prophylaxis. Ages at recruitment are a strong determinant of the risk of infection. Late usage of the MTCT prevention service is a risk for HIV infection in exposed infants.

Neurological diseases in children may be associated with mortality and long-term morbidity when they recover from acute ailments. The pattern of neurological disorders in an outpatient service may highlight the burden of these diseases. The objective of the present study is to describe the pattern of neurological disorders at the Pediatric Neurology Clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. A retrospective analysis of consecutive patients in a Pediatric Neurology Clinic of OOUTH, from 1st January 2011 till 31st December 2014, was carried out. A total of 4,476 patients attended the pediatric outpatient unit. Of these, 433 children had neurological disorders with a prevalence of 9.67%. The most frequent pediatric neurological disorders included seizure disorders (37.7%), cerebral palsy (37.7%), and central nervous system infections with complications (6.2%). The subjects with cerebral palsy were the youngest, while the subjects with seizures were the oldest. This study emphasizes that neurological disease contributes substantially to childhood morbidity in a semi-urban African tertiary hospital.

Objective: Little is known about the flaccid penile length in the newborn and the degree of stretch of the penis among investigators while measuring the stretched penile length. This study aimed to document the flaccid penile length and the stretch factor in the newborn.Methods: This cross-sectional study was carried out on 200 term male infants within the first 72 hours of life. The flaccid penile length and the stretched penile length were measured with a wooden spatula and the stretch factor was calculated.Results: The mean (±SD) flaccid and stretched penile length were 30.9 ± 3.8 mm and 38.9 ± 4.0 mm respectively. The mean stretch factor was 26.4 %. Both testes had the same mean volume of 1.6 ± 0.5 ml. There was a significant correlation between flaccid and stretched penile lengths (r = 0.775, p = 0.000). The flaccid penile length was a significant predictor of the stretched penile length.Conclusion: This study has been able to determine the stretch factor while measuring the flaccid and stretch penile lengths in Nigerian newborn infants. It is recommended that the flaccid penile length be measured along with the stretched penile length and determine the stretch factor in order to compare how much investigators stretch the penis during measurement. This will allow for detailed comparison of penile anthropometry across different ethnic groups and races. Keywords: flaccid penile length, newborn, stretch factor, stretched penile length.

BACKGROUNDSignificant morbidity and mortality in patients with sickle cell disease are accounted for by lung complications. To facilitate good respiratory care for children with sickle cell anaemia the generation of local predicted values is highly important.OBJECTIVETo determine the reference equations for spirometry indices estimation in children with sickle cell anaemia, which can be readily used as proxy when there is no easy accessibility to spirometer.METHODSA cross-sectional study with linear regression models developed to estimate reference values for spirometric indices in Nigerian children with sickle cell anaemia aged 5-12 years.RESULTSAge as independent variables for estimation of forced expiratory volume in 1 s (FEV1) was associated with lowest coefficient of determination (R2) and highest standard error. The coefficient of determination (R2) and standard error was highest and lowest, respectively, when arm span was used to determine peak expiratory flow rate (PEFR). Prediction models for PEFR and FEV1 gave the closest mean estimates that were 0.18 and 0.16 lower and higher than the actual mean PEFR and FEV1, respectively, but the differences was significant only in FEV1. On the contrary the prediction models for forced vital capacity (FVC) gave mean estimates that was 1.02 higher than the actual mean FVC, however, the finding was not significant.CONCLUSIONPreferred proxy for spirometry indices in children with sickle cell anaemia may be arm span.

Introduction exchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT. Methods a retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0. Results the mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies. Conclusion EBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.

Background: Sickle cell disease is the commonest genetic disorder of haemoglobin due to inheritance of mutant haemoglobin genes from both parents. The disorder is characterized by chronic haemolysis which results in increased availability of iron from red blood cell destructions. Objective: To determine the prevalence of iron overload among non-chronically blood transfused preschool children with sickle cell anaemia. Methods: Serum ferritin was assayed and transferrin saturation derived in 97 steady state sickle cell anaemia children. Elevated iron stores were defined as serum ferritin level >300ng/ml, and transferrin saturation >45%. . Results: Serum ferritin level was greater than 300 mg/ml in 14 (14.4%) subjects and transferrin saturation >45% in six (6.2%) subjects with sickle cell anaemia. The prevalence of iron overload was 20.6%. The prevalence of iron overload was higher among subjects in older age group, female, with history of blood transfusion, and with single blood transfusion session Conclusion: Iron overload is prevalent in older children; the number of blood transfusion sessions notwithstanding. Regular assessment of serum ferritin is recommended.

Objectives Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria.Design Descriptive case study.Setting Neonatal intensive care units in Nigeria.Participants Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria).Methods and analysis A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017–2018 and to assess challenges in service provision.Results In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems.Conclusion ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

To document normative data on penile size and anogenital distances of apparently normal term male infants in Sagamu, Nigeria.

Sickle cell disorders are the most common genetic disorders worldwide as well as in Nigeria. The weight and height are the most used anthropometric measurements in paediatric practice for the calculation of many parameters. The objective is to determine the reliability of weight and height estimates among children with sickle cell anaemia compared with measured weight and height. A random sample of SCA children aged eight months to 12 years was studied. Height and weight were measured using standard methods, while BMI was estimated using kg/m2. These were compared with estimated weight, height and BMI. Five subjects were adjudged obese using estimated BMI: three of these five subjects were identified as obese using actual BMI. Regression analysis showed that there appears to be more positive linear relationship for weight and length/height among children aged 1– 6 years. The measured mean weight and BMI were significantly lower than the estimated mean values. The overall mean of estimated length/height did not differ significantly from overall mean of the actual length/height. In comparison with the actual BMI, the estimated BMI did not identify any of the subjects with either thinness or overweight while children with obesity were over-estimated. The formula methods of estimating weights and heights for the various ages in children with sickle cell anaemia are over-estimating their actual values; this is more obvious for weight.