Outcome of Very Premature Newborns in a Referral Hospital in a Resource-Limited Setting

Background: In Cameroon, prematurity is considered among the first cause of neonatal mortality and the main cause of sequelae in children under 5 years old. Although some local teams have studied the causes of neonatal deaths, the survival of the very preterm babies in our context remains poorly known. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, covering a period of 5 years and 8 months, including 120 participants who presented with very preterm birth. Socio-demographic, anamnestic, and outcome features were studied. The assessment of the child’s psychomotor development was evaluated trough gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. Qualitative variables were expressed as numbers and percentages and quantitative variables as means ± standard deviations. Results: At the clinic, 23.8% of the children developed cerebral palsy, 3.1% had cerebral palsy with mental delay, and 6.6% had praxis disorders. Hearing impairment was observed in 6.3% of the survivors, visual impairment in 9%, and swallowing disorders in 7.6%. The mean developmental quotient was (89.98 ± 19.7) with a median of 93. A delay in developmental milestones was observed in 10.8%, speech disorder in 57%, severe malnutrition in 7.7%. The mortality rate was 48.5%. Conclusion: Very preterm birth is associated with a higher risk of neonatal death. Cognitive and motor disorders should not be underestimated. The harmonised management of very premature babies is highly recommended in our context for early diagnosis of sequelae.

Osteomyelitis in Children with Sickle Cell Disease: A Challenging Diagnosis: Case Report from Cameroon

Introduction: Sickle Cell Disease (SCD) is the most prevalent genetic disease in the world predominantly in the African population with Sickle Cell Anaemia (SCA) being its dominant form. One of the most frequent complications of SCD is osteomyelitis. SCA is due to a point mutation in the beta globin chain of haemoglobin. This is responsible for the sickled shape of RBCs under low oxygen tension conditions leading to obstruction in the microcirculation. This leads to vaso-occlusive crises (VOC) which has a similar clinical presentation to that of osteomyelitis, another complication of SCD. Case Presentation: We present the case of a three-year-old girl with SCA who presented with an inability to bear weight in a febrile context. A diagnosis of VOC was initially made, which was later on changed to both a left chronic tibial and right distal femoral osteomyelitis following a series of biological, and imaging investigations. Surgical debridement and drainage were performed, resulting 9 weeks later in the involution of fever and leg pain. Conclusion: Osteomyelitis when associated with SCD is a dreadful and deathly disease in low income countries as it also presents like VOC therefore higher suspicion index is recommended. It is therefore important to take this into consideration at an early stage in patients with homozygous sickle cell disease so as to rapidly initiate multidisciplinary care. Appropriate investigations, appropriate antibiotic therapy, and timely surgical intervention would help to greatly reduce morbidity and mortality.

Neonatal Transfer Situation Following Implementation of a Perinatal Network: An Analysis in Douala, Cameroon

Background: Postnatal transfer (PT) is interhospital transport of care-needing newborns. In 2016, a perinatal network was implemented to facilitate PT in the town of Douala, Cameroon. The network was supposed to improve PT-related care standards. This study aimed at determining characteristics of PT five years following the implementation of this network. Methods: A cross-sectional study was carried out from February to May 2021 at neonatology wards of six hospitals in Douala. Medical records of newborns transferred to the hospitals were scrutinized to document their characteristics. Parents were contacted to obtain information on PT route and itinerary. Data were analyzed using Epi Info software and summarized as percentages, mean and odds ratio. Results: In total, 234 of the 1159 newborns admitted were transferred, giving a PT prevalence of 20.2% (95% CI 17.9% - 22.6%). Male-to-female ratio of the transferred newborns was 1.3. Neonatal infection (26.5%), prematurity (23.5%) and respiratory distress (15.4%) were the main reasons for transfer. Only 3% of the PT was medicalized while only 2% of the newborns were transferred through perinatal network. On admission, hypothermia and respiratory distress were found in 31% and 35% of the newborns, respectively. The mortality rate among babies was 20% and these had a two-fold risk of dying (95% CI 1.58 - 3.44, p Conclusion: PT and the perinatal network are lowly organized and implemented in Douala. Sensitization of medical staff on in utero transfer, creating center for coordination of the network, and implementation of neonatal transport system could improve the quality of PT.