Browsing by Author "Mfingwana, Lunga"

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    The association of nucleated red blood cells with the severity and outcome in full-term Hypoxic Ischaemic Encephalopathy infants treated with therapeutic hypothermi
    (Stellenbosch : Stellenbosch University, 2018-12) Mfingwana, Lunga; Smith, Johan; Kali, Gugulabatembunamahlubi; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Abstract Title: The association of nucleated red blood cells with the severity and outcome in full-term Hypoxic Ischaemic Encephalopathy infants treated with therapeutic hypothermia. Background: Birth asphyxia results from deprivation of oxygen to a newborn infant during the peripartum and/or intrapartum period causing harm to the brain, heart, and other major organs. The damage to the injured brain may be permanent, depending on the severity of the insult. Birth asphyxia resulting in hypoxic ischaemic encephalopathy (HIE) is a worldwide problem commonly occurring in South Africa, accounting for thousands of perinatal deaths and stillbirths annually. There are limited biomarkers with a high sensitivity and specificity to accurately predict the severity of birth asphyxia, the risk of dying from the HIE and which newborn infants require referral to regional hospitals for therapeutic intervention. Ideally, the biomarkers should be applicable at a primary health care level, which contribute significantly to the number of HIE cases. Numerous publications have drawn attention to the association between the number of nucleated red blood cells (NRBC) and birth asphyxia. In contrast there are few biomarkers that predict the risk of developing severe HIE and even less that predict the long-term outcome of HIE. Objectives: We aimed to describe the association between NRBC, the severity of HIE, and 1year outcome in newborn infants treated for HIE with therapeutic hypothermia. Methods: This was a prospective descriptive sub-study of a larger study investigating therapeutic hypothermia (TH) of neonates with HIE at Tygerberg Hospital (TBH). A cohort of 100 patients with varying degrees of HIE admitted for cooling were recruited into the study. Clinical notes on Enterprise Content Management (ECM) database and cooling booklets, used routinely to prospectively record data on all therapeutically cooled neonates, were reviewed. NRBC done within 6 hours of admission were analyzed. Patients were followed up after discharge, over a period of 12 months, by a single developmental specialist. They were assessed using the Bayley Scales of Infant Development Third Edition Screening Test (Bayley-111® Screening Test). Results: 75 patients had complete data. The mean gestation and birth weight was 38.6 (4.8) weeks and 3116.8 (+610) grams, respectively. Patients were divided into mild (n=42), moderate (n=20) and severe (n=13) HIE using the Thompson score. Using the NRBC patients were stratified into 3 categories; NRBC 0/100WBC (n=36), NRBC 1-29/100WBC (n=31) and NRBC 30/100WBC (n=8). We found no statistically significant difference in HIE severity between infants born inside and outside TBH (p =0.473). The inborn infants had a significantly higher number of infants with NRBC 30/100WBC (p= 0.005;Odds ratio 8.167 95% CI 1.5-44.27). There was no significant association between the category of NRBC and HIE severity (p=0.265). There was a significant association between infants with cerebral palsy and/or neurodevelopmental delay at 12 months of age and NRBC 30/100WBC (P=0.013; Odds ratio 20.17; 95% CI 1.017 – 399.6); Similarly, children that died on the initial admission to the NICU for therapeutic hypothermia had significantly higher levels of NRBC when compared to those that survived; (P=0.008; Odds ratio 9.40; 95% CI 1.7791 to 49.6649). Conclusion: In newborn infants suffering from HIE requiring therapeutic cooling a NRBC 30/100 WBC, collected in the first 6 hours of life, had a significant correlation with early mortality and neurodevelopmental impairment at 1 year of age.
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    Bronchoscopy in children with COVID‐19 : a case series
    (John Wiley & Sons, 2020) Goussard, Pierre; Van Wyk, Lizelle; Burke, Jonathan; Malherbe, Annemie; Retief, Francois; Andronikou, Savvas; Mfingwana, Lunga; Ruttens, Dries; Van der Zalm, Marieke; Dramowski, Angela; Da Costa, Aishah; Rabie, Helena
    Introduction: The coronavirus disease‐2019 (COVID‐19) era is a challenging time for respiratory teams to protect their patients and staff. COVID‐19 is predominantly transmitted by respiratory droplets; in the clinical setting, aerosol generating procedures pose the greatest risk for COVID‐19 transmission. Bronchoscopy is associated with increased risk of patient‐to‐health care worker transmission, owing to aerosolized viral particles which may be inhaled and also result in environmental contamination of surfaces. Methods: We describe our experience with the use of modified full‐face snorkeling masks for pediatric bronchoscopy procedures in four COVID‐19 infected children when filtering facepieces/respirators were in limited supply. Results: Bronchoscopy was urgently required in four children, and could not be delayed until COVID‐19 test results were available. During the pandemic peak, when respirators were in short supply, modified full‐face snorkel masks (SEAC Libera, SEAC, Italy) were worn by the bronchoscopy team. Each mask was fitted with an O‐ring, adapter, and heat and moisture exchanger filter. To date, there have been no COVID‐19 infections among the bronchoscopy team staff, whereas the overall Hospital staff COVID‐19 prevalence rate has exceeded 13.5% (667/4949). Conclusion: Emergency bronchoscopy procedures on COVID‐19 infected patients or patients with unknown infection status can be safely performed using modified full‐ face snorkel masks.
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    Corrosive injury of the trachea in children
    (Wiley Open Access, 2019) Goussard, Pierre; Mfingwana, Lunga; Morrison, Julie; Ismail, Zane; Wagenaar, Riegart; Janson, Jacques
    ENGLISH ABSTRACT: The secondary injury may present weeks to months after the initial insult and repeat bronchoscopy, and long‐term follow‐up is required for the respiratory complications of CSI. Ingestion of caustic fluid may cause severe tracheal stenosis. Repeated airway dilatation may be a lifesaving intervention until such point that surgery can be performed.
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    Hybrid lesion in a child presenting with cough, fever and haemoptysis
    (BMJ Publishing Group, 2020-10-08) Goussard, Pierre; Andronikou, Savvas; Mfingwana, Lunga; Janson, Jacques
    ENGLISH ABSTRACT: A 10-year-old boy presented with minimal haemop-tysis after 1 week of cough and fever. He had a similar presentation 3 years earlier; the diagnosis at that stage was right lower lobe pneumonia. He is HIV uninfected and has no known tuberculosis exposure. Investigations revealed a raised white cell count of 19.0×109 /L, raised C reactive protein 217 mg/L, normal clotting studies and the GeneXpert MTB/RIF was negative.
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    Pulmonary Echinococcus in children: a descriptive study in a LMIC
    (Stellenbosch : Stellenbosch University, 2021-12) Mfingwana, Lunga; Goussard, Pierre; Van Wyk, Lizelle; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    Background: Echinococcus granulosus is a major public health problem in lower middle- income countries (LMIC). Children are commonly diagnosed with cysts in the lungs and/or the liver. Objectives: The purpose of this study was to describe a pediatric cohort diagnosed with pulmonary cystic echinococcus (CE) and treated with a combination of medical and surgical therapy. Methods: This was a retrospective study performed between July 2017 and December 2020 at Tygerberg Hospital, South Africa. Clinical, laboratory, radiological, medical, and surgery-related outcomes were reviewed. Results: The cohort consisted of 35 children, 17 (49%) were male, with a mean age of 9 ±5.4 years and a mean weight of 20.3 ±8.3 kg. The most frequently encountered presenting symptom was cough (93%) followed by fever (70% ). Isolated pulmonary CE accounted for the majority of cases (74%) with left lower lobe predominance. A significant proportion of the cohort exhibited chest computed tomography (CT) characteristics consistent with complicated pulmonary CE. Eighteen (58%) children had a positive indirect hemagglutination assay test result. All children received medical treatment whilst 3 0 (86%) of children required surgery. Children with complicated pulmonary CE stayed a mean of 12.5 ±6.6 days, while those with simple cysts stayed 6.8 ±1.5 days. Conclusion: Isolated pulmonary CE is common in children, whereas extrapulmonary cysts are uncommon. Pulmonary CE is diagnosed using CXR, and CT imaging. IHA serology has limited diagnostic utility for pulmonary CE. Combined surgery and chemotherapy remain the gold standard for treating pulmonary CE.