African Journals OnLine
Nigerian Journal of Paediatrics

Volume 30 No. 2 April 2003
ABSTRACTS

Body Mass Index and Sexual Maturation in Adolescent Patients with Sickle Cell Anaemia

Ozigbo CJ, Nkanginieme KEO.

Background: Sickle cell anaemia (SCA) is associated with delayed sexual maturation. The Body Mass Index (BMI) or Quetelets Index is closely linked to events of puberty in normal children. We have so far, found no reports on studies on the relationship between BMI and puberty in patients with SCA.

Objectives: To evaluate sexual maturation in patients with SCA, and determine the influence of BMI on the onset of sexual maturation.

Design: A cross-sectional study carried out in Port Harcourt, Rivers State, from June 1999 to June 2000.

Patients and Methods: One hundred and twenty four adolescents with SCA as well as the same number of matched normal controls were evaluated. A structured questionnaire was used to obtain information on personal data and determinants of socio-economic class. Weight, height (HT) and BMI were obtained and sexual maturation assessed.

Results: Fifty-seven (46.0 percent) males and 67 (54.0 percent) females with SCA as well as their matched controls were evaluated. The mean age at onset of sexual maturation was 14.6±1.4 years for males with SCA and 12.1±1.3 years for the controls. Among the females, this was 14. 2±1.7 years for the patients and 11.4±0.8 years for the controls. The observed differences were statistically significant (P<0.05). The average BMI of SCA patients in Sex Maturity Rating (SMR) 2 was also significantly higher (P<0.05) than the average values in SMR 1 for both sexes.

Conclusion: Sexual maturation is delayed in patients with SCA compared to matched controls. The average BMI obtained at onset of sexual maturation (SMR 2) is significantly higher than values obtained in the prepubertal stages (SMR 1) in both sexes. This suggests that, regardless of chronological age, some increase in body fat and size, as reflected in BMI, is associated with onset of sexual maturation in patients with SCA.

Key Words: Sexual maturation, Puberty, Sickle cell anaemia, Body Mass Index, Sex Maturity Ratings.

Nigerian Journal of Paediatrics 2003; 30:39.

Childhood Acute Glomerulonephritis in Benin City

Ibadin OM, Abiodun PO.

A prospective study of consecutive cases of acute glomerulonephritis (AGN) in 63 children was conducted at the University of Benin Teaching Hospital (UBTH), between January 1996 and December 2000. There were 28 (44.4 percent) males and 35 (56.6 percent) females whose ages ranged from 0.2-15.0 years. The mean age of the males (6.6 + 4.3 years) did not vary significantly from that of the females (7.6 + 3.6 years) (t = 0.30; p > 0.50). The peak age incidence for both genders was three years. The lowest annual incidence of nine was seen in 1997 while the highest of 17 occurred in 2000. About 90 percent of the patients came from low socio-economic class families. Presenting features included oedema (93.7 percent), hypertension (82.5 percent), oliguria (47.6 percent) and pulmonary oedema (39.7 percent). Others were headache (11.1 percent) and convulsion (4.8 percent). Haematuria and proteinuria of varying degrees occurred in all the patients, while antecedent infections were noted in 49.2 percent. Complications included congestive cardiac failure (39.7 percent), urinary tract infection (20.6 percent), acute renal failure (12.7 percent), and hypertensive encephalopathy (4.8 percent), while mortality was 3.2 percent. Two cases each, developed nephrotic syndrome and chronic renal failure after about two years of follow up. Despite geographical variations, the pattern of the disease was similar to what obtains in other centres in the country.

Nigerian Journal of Paediatrics 2003; 30:45

Bowel Habits of Preterm Infants in Ilorin

Adegboye OA, Ojuawo A, Adeniyi A.

Objective: To determine the pattern of bowel habits of preterm infants in the first 10 days of postnatal life.

Methods: One hundred and forty preterm infants delivered at the University of Ilorin Teaching Hospital (UITH) or referred to it within twelve hours of delivery, were studied. The babies were divided into two equal groups namely, those less than 33 weeks (group 1) and those between 33 and less than 37 weeks of gestation (group 2); 40 term babies were included in the study for comparison. The volume of feeds (where applicable), the age at first feeding, frequency of stools passed and the colour of the stools were recorded.

Results: The first stool was passed at 32.2± 27.5 hours in babies <33 weeks (group 1), at 21.8±15.8 hours in those between 33 and <37 weeks of gestation (group 2) and at 14.3±12.4 hours in the term babies. Although there was a significant indirect relationship between gestational age at birth and the time of passage of the first stool (p = 0.000078), the onset of enteral feeding was not a factor for initiating passage of the first stool; it however, had a direct relationship with the onset of transitional stool. The gestational age had an inverse correlation with the duration of passage of transitional stool (r=0.31 and p<0.001). The average frequency of stools/day increased with gestational age from 0.67 (group 1) and 0.57 (group 2) on the first postnatal day to a peak frequency of 1.80 and 2.00 respectively, during the first week of life. After this, there was a decrease, in spite of increasing milk intake.

Conclusion: The average frequency of stools/day in exclusively breastfed infants increases with gestational age. Most preterm and term neonates fed on breast milk produce predominantly soft stool during the first 10 days of life. It is hoped that the data produced from this study will serve as a reference for comparison with studies from other countries where exclusive breastfeeding is practised

Nigerian Journal of Paediatrics 2003; 30: 50

Differential Cell Count of Bone Marrow Aspirates in Steady-state Sickle Cell Anaemia Patients

Akinsulie AO, Akanmu AS, Esan OA...

Background: Megaloblastic arrest of the bone marrow is one of the causes of anaemic crises in patients with sickle cell anaemia. The diagnosis of this condition will require that the reference level of megaloblastosis during steady state be properly documented.

Objectives:To document a reference differential cell count in the bone marrow aspirates of patients with sickle cell anaemia and determine the level of megaloblastosis that can be regarded as indicating megaloblastic crisis in such patients.

Design: Systematic counting of haematopoietic cells in the bone marrow of children with confirmed Hb phenotype SS who are in steady state.

Subjects and Methods: The subjects were 11 of 68 children with sickle cell anaemia attending the paediatric outpatient clinic at the Lagos University Teaching Hospital, Lagos, in respect of whom parental consent for bone marrow aspiration was obtained. About 4.5 ml of blood was obtained from the antecubital vein of each child, for full blood count. Bone marrow was aspirated from the posterior superior iliac spine. Slides were stained with MayGrünwald-Giemsa stain. Proportions of erythroid, myeloid, lymphoid and megakaryocytic cells out of 250 nucleated bone marrow cells were determined.

Results: Steady state mean packed cell volume (PCV) was 0.2 ± 0.017 L/L. The mean reticulocyte count was 5.9 percent (95% CI, 5.3 – 7.0%) and the mean cell volume was 91.8 ± 2.7 fl. Erythroid precursors constituted 34.5 percent of the total nucleated bone marrow cells (NBMC). Of these, polychromatic and orthochromatic erythroid blasts predominated, constituting 49 and 36percent respectively, of total erythroid precursors. Polychromatic and orthochromatic megaloblasts constituted 16.5percent (95% CI, 7-25%) of total NBMC or 47.8 percent of erythroid precursors. The myeloid erythroid ratio was 1:1. The reference range of megaloblasts was 8-26 percent of the NBMC.

Conclusion: Patients with sickle cell anaemia in steady-state may show megaloblastic bone marrow changes even with routine folate supplements. Megaloblastic crisis should not be diagnosed until megaloblasts are in excess of 26 percent of the total NBMC.

Nigerian Journal of Paediatrics2003;30:54

Neonatal Maximum Thigh Circumference Tape: An Alternative Indicator of Low Birth Weight

Ezeaka VC, Egri-Okwaji MTC, Renner JK, Grange AO.

Background: The birth weight of an infant is a significant determinant of morbidity. Birth weight measurement is not always feasible in developing countries thus necessitating alternative measurements as surrogates.

Objective: This study was undertaken to determine the most appropriate maximum thigh circumference (MTC) measurements corresponding to birth weights of <2500g and <2000g respectively, and to propose the design of a standardized tricoloured MTC Tape to identify low birth weight (LBW) neonates promptly, for appropriate intervention.

Methods: Anthropometric measurements were carried out on 788 neonates within 24 hours of delivery. The MTC measurements were then correlated with other anthropometric values. Based on the results obtained, a maximum thigh circumference tape that would be capable of distinguishing neonates with birth weights <2500g and < 2000g, respectively, was proposed.

Results: The mean MTC of the neonates increased as the birth weights (F statistics = 80.66; p<0.0001) and gestational ages increased (F statistics = 136.73; p<0.001). A strongly positive correlation was obtained between birth weight and MTC (r=0.95; p<0.0001) with a regression equation of y=8.25 + 0.003x, followed by MAC (r=0.86), length (r=0.85), gestational age (r=0.66) and OFC (r=0.64). MTC values of £15.5cm and £14.9cm had the best combination of sensitivity and specificity for predicting newborns with birth weights of <2500g and <2000g, respectively.

Conclusion: Using the cut-off values obtained, the neonates were categorized into three risk groups (“high risk”, “moderate risk”, and “low risk”), and a tricoloured MTC Tape was subsequently designed, using these inferences.

Key words: Maximum thigh circumference, low birth weight, indicator.

Nigerian Journal of Paediatrics 2003; 30: 60.

Septic Arthritis of The Hip Joint presenting as Acute Abdomen

Alonge TO, Ogunlade SO, Omololu AB, Obajimi M.

Septic arthritis of the hip joint in two children, originally thought to be cases of acute abdomen is presented. In one case, the discovery of extra-peritoneal purulent fluid at surgery, obviated the need for laparotomy and in the other, the true nature of the disease became apparent one week after laparotomy. These cases illustrate the maxim that any painful movement of the hip joint with associated unexplained fever should raise suspicion of septic arthritis. The close relationship of the hip joint to the pelvis sometimes confuses hip diseases with pelvic pathologies.

Key Words: Septic arthritis, acute abdomen, pathological dislocation

Nigerian Journal of Paediatrics 2003; 30: 67.