Masters Degrees (Paediatrics and Child Health)
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Browsing Masters Degrees (Paediatrics and Child Health) by browse.metadata.advisor "Finlayson, Heather"
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- ItemClinical characteristics and outcome of children evaluated and treated at Tygerberg Children’s Hospital during a measles epidemic(Stellenbosch : Stellenbosch University, 2014-04) Ferreira-Van Der Watt, Talita Aletta; Finlayson, Heather; Rabie, Helena; Cotton, Mark F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.ENGLISH ABSTRACT: Objective: To describe the clinical characteristics and outcome of children presenting to Tygerberg Children’s Hospital with measles infection Methods: This was a retrospective, descriptive study of children presenting to Tygerberg Children’s Hospital, from 1 February to 31 March 2010 with a diagnosis of measles, during the measles epidemic of 2009/2010. Folders of every second admission were reviewed. Data was analysed using Statistica version 10 of 2012. The study was approved by Stellenbosch University Ethics Committee. Results: Five hundred and eighty five children were seen and evaluated for complicated measles, 239 patients were included. Seventy nine percent (n=189/239) were admitted of which 54.3% were male. The median age at admission was 9 (Interquartile range 6 to 19) months. Children less than 9 months accounted for 50.2% (n=120) and 25.9% (n=62) were less than 6 months of age. The median WHO weight-for-age Z-score (WAZ) was 0.69 (IQR - 1.82 to 0.29), malnutrition was found in 39.9% (n=81) of children less than 5 years. Children residing in the Khayelitsha sub-district accounted for 43.1% (n=103) of the study population. Uptake of the first dose of measles vaccine was 31.1% and of the second dose of measles vaccine was 23.8%. The median length of stay (LOS) was 3 days (IQR 2 – 5 days). Gastroenteritis (67.4%; n=161) and pneumonia (54.4%; n=130) were the most common complications. The majority assessment. A single dose of children had more than one complication at the time of of vitamin A was received by 71.1% (n=170/239) of children during evaluation and 47.6% (n=114/239) received 2 doses. Seven (2.9%; n=7/239) patients required ICU care. Four (57.1%; n= 4/7) were less than 9 months of age. Pneumonia (85.7%; n=6) was the most common reason for admission. Four (1.7%; n=4/239) children died. The median age at death was 9 months (IQR 7 – 14 months). Pneumonia (75%; n=3/4) was the most common cause of death. HIV testing was done in 40.6% (n=97/239) of children. HIV exposure was found in 28.9% (n=69/239) on history. HIV infection was present in 8.4% (n=20/239) of children, of these, 60% (n=12/20) were on HAART. HIV-infected children were older than HIV-uninfected children (median 40 and 9 months respectively, p=0.003). Thirty percent (n=6/20) of HIV- infected children had received any measles vaccination prior to admission. Five percent (n=1/20) of HIV-infected children died vs 4.2% (n=3/72) of children who were confirmed HIV negative. Conclusion: Our study showed that measles causes a significant burden of morbidity and mortality in children. HIV infection however did not increase the morbidity and mortality due to measles co-infection. Interventions to improve vaccination rates and practices at community level are required in order to prevent further epidemics in the future. Further research is needed to determine whether the first measles vaccine dose should be given earlier rather than 9 months of age in order to prevent early infection.
- ItemA retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital from 2006 – 2016: is empiric ampicillin still indicated past the early neonatal period(Stellenbosch : Stellenbosch University, 2018., 2018-12) Oppel, Kim; Finlayson, Heather; Holgate, Sandi; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.ENGLISH ABSTRACT: Background: Ampicillin to treat Listeria Monocytogenes (LM) infection is empirically added to the treatment of infants (<3 months) with suspected sepsis or meningitis. In view of the limited LM cases, paucity of South African data and an ampicillin shortage, we aimed to describe the occurrence of LM infections at Tygerberg Hospital (TBH) with the aim of rationalising the paediatric antibiotic policy. Methods: An 11 year (2006-2016) retrospective descriptive study of children (<13 years) from TBH and referral hospitals with a positive blood or cerebral spinal fluid (CSF) culture for LM was conducted. Results: Of 26 positive cultures for LM, 23 (88%) occurred in infants <3 months of age, all <10 days old. Approximately half (56.5%, 13/23) were born at or referred to TBH. Presentation occurred on the day of delivery in 46% (6/13) and 92% were admitted to the neonatal intensive care unit (NICU), 8/13 (62%) died. Neonates treated at peripheral hospitals had statically higher cerebral spinal fluid examinations (90% vs 31% (p=0.019)), a higher platelet count (239x109/L vs 107x109/L (p=0.004)), lower CRP (64 mg/L vs 137 mg/L (p=0.01)) and a lower mortality rate (0% vs 62% (p=0.002)). The incidence of LM at TBH was 0.04/1000 live births, and 2.3/1000 NICU admissions. Conclusion: As in other countries the local neonatal LM incidence is low. Neonates present in the 1st week of life with severe disease and a high mortality rate. This data supports a change in antibiotic policy, in keeping with international guidelines, limiting empiric ampicillin prescription to infants <1 month old.