Proteinuria in Children Living with HIV on Highly Active Antiretroviral Therapy (Haart)

Objective: To determine the prevalence of proteinuria in children living with HIV (CLHIV) and identify associated factors. Patients and methods: This was a cross-sectional, descriptive and analytical study carried out from April to August 2017 in the HIV care centres in Brazzaville and Pointe-Noire. The study included CLHIV with dipstick urinalysis test “Combur10 Test® M”. Results: Thirty seven CLHIV on HAART presented a proteinuria, 21.8%. Children were male gender in 21 cases (56.8%) and female gender in 16 cases (43.2%). Mean age was 10.9 ± 3.9 years. The children were infected with type 1 virus in 35 cases (94.6%), vertical transmission in all the cases (100%). Children were living with HIV for about 2 to 4 years of average n = 18 (48.6%) and they were WHO clinical stage 2 in 18 cases (48.6%). 13 children (35%) had CD4 level < 200 cells/mm3. All CLHIV (100%) were on HAART thus 20 (37.7%) on the combination of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP). This combination AZT, 3TC, NVP was a protective factor regarding the occurrence of proteinuria (OR: 0.43;IC (95%). Conclusion: Proteinuria is less observed in CLHIV on HAART. Systematic screening and early management of proteinuria during follow-up of these children improve their survival.

Excessive Alcohol Intake and Cigarette Smoking among Black Schoolchildren in a Central African City (Brazzaville, Congo)

Objective: To determine the prevalence of excessive alcohol intake (EAI) and cigarette smoking (CS) in schoolchildren of Brazzaville. Methods: This cross sectional survey included a representative population of schoolchildren in Brazzaville (603 schoolchildren divided 325 girls and 278 boys). Results: The prevalence of EAI was 9% (n = 54). The mean age of EAI children was 16.2 ± 1.3 years (range: 13 - 18 years) vs 11.4 ± 3.4 years (range: 5 - 18 years) for no EAI children (p Conclusion: Low social level, siblings, addictions in parents were correlate addictions in schoolchildren. It is necessary to prevent the acute and futures complications of this addiction in our children.

Rare Neonatal Digestive Surgical Emergencies at the Brazzaville University Hospital Center

The purpose of our study was to evaluate the morbidity-morality of rare neonatal digestive emergencies in order to improve their management. Observations: 7 newborns ranging in age from 6 hours to 3 weeks were treated for rare digestive pathologies between January 2013 and July 2017 (a period of 3 years and 6 months) in the Department of Pediatric surgery of Brazzaville University Center, Congo. Males were predominant (5 versus 2 females). Pathologies listed were: 1 antenatal volvulus of the small intestine, 1 annular pancreas and 5 gastric perforations. The average time of care in the operating room was 12 hours. The newborns were hospitalized in the pediatric surgery department in 28.6% of cases (n = 2), and 71.4% (n = 5) in the neonatology department. The antenatal volvulus of the intestine and annulus pancreas were integrated into a nosologic entity named neonatal occlusion (NNO). The postoperative outcomes were simple for 4 patients (57.14%) while 3 patients died immediately after surgery (42.86%). Conclusion: Neonatal surgical emergencies are still difficult to manage in our context. The lack of knowledge of these rare pathologies, which delays their management, considerably increases morbidity-mortality. The critical analysis of this series highlights diagnostic and therapeutic difficulties particularly with gastric perforations, hence the interest of better popularization of pediatric surgery.

The Fate of Newborns Delivered through Cesarian Section at Brazzaville University Hospital

Objectives: To assess the fate of newborns born by emergency Cesarean section during the early neonatal period at the University Hospital Centre (UHC) in Brazzaville, with a view to improving neonatal prognosis. Patients and methods: This was a descriptive and cross-sectional analytical study of exposed and unexposed type, which took place from 24 March 2018 to 24 May 2018. All cases of newborns born by Cesarean section were included. Children born by extreme emergency and urgent Cesarean section were considered as exposed, and the others not exposed. The variables studied were the epidemiological characteristics of the mothers, the history of pregnancy and its management, anthropometric data on the newborn, the state of the child at birth and monitoring up to the seventh day. The test for comparing the proportions of target groups related to the child’s condition was used. Results: The mothers were aged 20 to 29 years (extreme 16 to 44 years);32 of them (22.5%) had a scarred uterus;29 pregnant women (20.4%) had a pathology associated with pregnancy. The distance travelled to consult was between 5 and 10 Km (63 cases or 44.3%). Emergency Caesarean sections were performed in 110 patients (77.5%) and scheduled Caesarean sections in 32 pregnant women (22.5%). Localoregional anaesthesia by spinal anaesthesia predominated (78.9%), by the association Bipivancaine + Fentanyl (69 cases or 48.6%) whose practitioner was often the nurse anaesthetist (131 cases or 92.3%). No accidents have occurred intraoperatively. At birth we noticed: 4.2% stillbirth, 19.7% bad, requiring resuscitation of at least 5 minutes for 16 newborns (57.1%). 26 newborns (18.3%) required care in the Neonatology Department. Early neonatal morbidity was dominated by respiratory distress (10 cases or 38.5%), early neonatal infection (5 cases or 19.1%) and a lethality rate of 19.2%. Conclusion: The future of the newborn, born by emergency Cesarean section is mixed;emergency control can improve the situation.

Jaundice in the Newborn at the Teaching Hospital of Brazzaville

Introduction: Jaundice is a major symptom during neonatal time. It is defined by a bilirubin ≥ 50 mg/l. Objectives: To determine the frequency of neonatal jaundice at the Brazzaville University Hospital, to determine the main etiologies, to evaluate the management, to specify the evolution. Patients and Method: It was a prospective and descriptive study that was conducted in the Neonatology Department and Biochemistry Laboratory of the University Hospital of Brazzaville, from 1st August 2015 to 31st July 2016. It included newborn children admitted into the neonatal unit for treatment of jaundice. The variables studied were epidemiological, clinical, etiological therapy and outcome. Results: The frequency of the neonatal jaundice is 7.2%. The hyperbilirubinemia as not conjugated was found in 99.1% of cases. The main causes are bacterial neonatal infection n = 102 (47.9%), the physiological icterus n = 46 (21.6%) and the ABO incompatibility n = 40 (18.8%). The treatment consists of the phototherapy in all cases. Each phototherapy session lasts 3 hours n = 99 (56.9%), 6 hours n = 58 (33.3%) and 12 hours n = 17 (9.8%). The average duration of the administering of the therapy is of 3 ± 2 days. Hyperbilirubinemia encephalopathy occurred in 62 (29.1%) cases, including 49 cases of kernicterus. The death occurred in 70 (32.9%) children. Conclusion: The importance and the gravity of the neonatal jaundice require primary preventive means based on proper care in pregnancy and the birth. While the secondary prevention includes high index of suspicion, comprehensive diagnostic equipment availability to prevent acute bilirubin encephalopathy.

Late Neonatal Mortality at Teaching Hospital of Brazzaville (Congo)

Background: Neonatal mortality is a major public health problem. Its reduction is one of the targets of the objectives for sustainable development. Objectives: To determine the frequency of late neonatal mortality, to determine the causes of death and to identify the factors associated with late neonatal mortality at Brazzaville University Hospital. Patients and methods: This was a descriptive and analytical study conducted in the neonatal department of the Brazzaville University Hospital from 1 January to 30 June 2018. It concerned all newborns admitted to the service and died between 7th and 28th day of life. The variables studied were epidemiological, clinical and evolutionary. For the study of the factors associated with late mortality, we compared the deceased newborns with those hospitalized in the service whose stay was at least seven days. The materiality threshold was 5%. Results: During the study period, 697 newborns were admitted to the service, 286 (41%) died, 79 (27.6%) on the seventh day or beyond. The median age at admission was one hour. These were male (44.3%) and female (55.7%) newborns. The causes of death were prematurity (50.7%), neonatal infection (36.7%), perinatal asphyxia (6.3%) and others (6.3%). The mean age at death was 13.5 ± 6.4 days (range: 7 and 28 days). Prematurity OR = 3.62 (95% CI: 1.2 - 10.6) is the factor associated with late mortality. Conclusion: Reducing late neonatal mortality requires the implementation of measures to improve the human and material capacities of the service.