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Jaundice in the Newborn at the Teaching Hospital of Brazzaville

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Open Journal of Pediatrics 2019年第2期9卷 111-118页

作者： gaston ekouya bowassa Giresse Tsouassa Wa Ngono Neli Yvette Ngakengni Engoba Moyen Koumou Onanga Steve Missambou Mandilou Georges Moyen Faculty of Health Sciences Marien NGOUABI University of Brazzaville Brazzaville Congo Department of Neonatology University Hospital of Brazzaville Brazzaville Congo Department of Biochimy University Hospital of Brazzaville Brazzaville Congo

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.

关键词： Jaundice Neonatal Phototherapy Bilirubin Encephalopathy

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

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Open Journal of Obstetrics and Gynecology 2019年第7期9卷 1073-1082页

作者： Jean Alfred Mbongo Gickelle Bitsene Mpika Peggy Mawandza Delvie Ardèche Bitsangou gaston ekouya bowassa Clotaire Itoua Leon Herve Iloki Obstetrical Gynecology Department Brazzaville University Hospital Brazzaville Congo Polyvalent Resuscitation Department Brazzaville University Hospital Brazzaville Congo Neonatology Department Brazzaville University Hospital Brazzaville Congo

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

关键词： Newborns Emergency Caesarean Sections Congo

Acute Renal Failure in Children at the University Hospital of Brazzaville

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Open Journal of Pediatrics 2019年第3期9卷 253-271页

作者： Engoba Moyen Verlem Bomelefa-Bomel gaston ekouya-bowassa Tony Eyeni Sinomono Aymar Pierre Gildas Oko Bertrand Fikahem Ellenga Mbolla Georges Marius Moyen Intensive Care Pediatric Department University Hospital of Brazzaville Brazzaville Congo Neonatology Department University Hospital of Brazzaville Brazzaville Congo Nephrology Department University Hospital of Brazzaville Brazzaville Congo Cardiology Department University Hospital of Brazzaville Brazzaville Congo

Introduction: Acute renal failure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: Included were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% resulted from severe dehydration. No extra-renal treatment was performed. Lethality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and severe malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, absence of an extra-renal purification center were factors associated with mortality (p Conclusion: The high prevalence of ARF and its lethality requires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.

关键词： Acute Renal Failure Child Brazzaville

Current Status of Acute Rheumatic Fever and Relationship with Acute Rheumatic Heart Disease at the University Teaching Hospital of Brazzaville (Congo)

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World Journal of Cardiovascular Diseases 2019年第11期9卷 812-819页

作者： Bertrand Fikahem Ellenga Mbolla gaston ekouya-bowassa Pierre Poathy Moyen Engoba Annie Rachel Okoko Aurore Mbika-Cardorelle Suzy-Gisèle Kimbally-Kaky Department of Doctotal Studies Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Department of Pediatrics University Teaching Hospital of Brazzaville Brazzaville Congo

Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 to December 2016 (5 years) in the Department of Pediatrics. We had included patients aged from 5 to15 years old, admitted for ARF. Results: Twenty-nine black African children, 15 boys (51.7%) were included. The incidence was 5.8 cases/year. The mean age was 10.4 ± 2.7 years. The mean age of parents was 34.5 ± 6.9 years (range: 24-48) for mother and 41.2 ± 6.9 years (range: 28 - 56) for father. Parents were low-income 10 (34.5%), the delay of consultation was 17.7 ± 19.5 days. The medical history was: frequent pharyngitis 22 (76%), previous ARF 17 (58.6%), previous hospitalization 11 (38%). Signs were: polyarthralgia (n = 28, 96.6%), fever (n = 24, 82.8%), asthenia (n = 18, 62%), migratory polyarthritis (n = 12, 41.4%). Organic heart murmur has been reported in 13 cases (44.8%), and heart failure in 7 cases. The anomalies of blood analysis were inflammatory syndrome (100%), elevation of streptococcal enzymes (n = 27, 93%), and anemia (n = 16, 55.2%). In cardiac ultrasound, anomalies were: thickened valve (n = 13, 44.8%), mitral regurgitation (n = 13, 44.8%), dilatation of left ventricle (n = 9, 31%), aortic regurgitation (n = 5, 17.2%). The nosology of pathology was acute RHD (n = 15, 51.7%), ARF only (n = 14, 48.3%). Associated factors of acute RHD were: female sex (OR 1.52, 95%CI 0.35 - 6.6), low-income (OR 1.33, 95%CI 0.24 - 7.4), previous hospitalization (OR 2.7, 95%CI 0.58 - 13) and migratory polyarthritis (OR 1.12, 95%CI 0.25 - 4.9). Conclusion: The ARF remains prevalent in our countries. Its complications lead to sequelae that are difficult to treat, because of the lack of cardiac surgery centers in many sub-Saharan African countries including Congo. Prevention and effective treatment of angina should be applied by practitioners.

关键词： Acute Rheumatic Fever Rheumatic Heart Disease Infants Black African Sub-Saharan Africa

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

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Open Journal of Pediatrics 2017年第1期7卷 18-25页

作者： Annie Rachel Okoko gaston ekouya bowassa Bertrand Fikahem Ellenga Mbolla Moyen Engoba Paul Ossou-Nguiet Suzy-Gisèle Kimbally-Kaky Georges Marius Moyen Department of Doctoral Studies Faculty of Health Sciences Marien Ngouabi University of Brazzaville 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.

关键词： Smoking Alcohol Child School Sub-Saharan Africa

Asthma in Children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville (Congo)

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Open Journal of Pediatrics 2017年第3期7卷 140-148页

作者： Engoba Moyen Esthel Lee Presley Bemba Judicael Kambourou gaston ekouya-bowassa Evrard Romaric Nika Grace Nkounkou Verlem Bomelefa-Bomel Annie Rachelle Okoko Georges Moyen Jean-Louis Nkoua Faculty of Health Sciences Marien Ngouabi University of Brazzaville Brazzaville Congo Pediatric Intensive Cares Unit University Hospital of Brazzaville Brazzaville Congo Department of Pneumology University Hospital of Brazzaville Brazzaville Congo Department of Neonatology University Hospital of Brazzaville Brazzaville Congo

Objectives: To describe the epidemiological, clinical and therapeutic aspects of asthma in children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville. Patients and methods: We reviewed the records of children hospitalized in the Pediatric Intensive Care Unit of University Hospital of Brazzaville from January 1 to December 31, 2015, and retained those from two months to 17 years hospitalized for asthma. The study variables were: age, sex, influence of seasons, history of atopy;the factors triggering the crisis, the type of follow-up, the degree of severity of asthma exacerbation, the type of treatment instituted and the course of the disease. In total, out of 2012 hospitalized children, 65 children met the inclusion criteria. Results: The hospital prevalence of asthma was 3.5%. Among 65 children of study, 42 (59.2%) were male and 29 (40.8%) female. The mean age was 3.9 ± 2.9 years (range from 2 months to 14 years). Children aged 30 months to 5 years were the most represented (40%). They were known as asthmatics, n = 18 (27.7%). Family atopy was found, n = 11 (16.9%). Acute Otorhinolaryngologic infections were in all cases the factors triggering the crisis. The peak frequency of hospitalizations for asthma occurred during the short rainy season. The crisis was moderate n = 46 (70%) and severe n = 19 (29%). Beta 2 mimetics were administered in all cases, by subcutaneous in 18 cases (27.7%) and inhaled in 47 cases (72.3%). The outcome was favorable in all cases with a mean hospital stay of 1.46 ± 0.92 days. Conclusion: Childhood asthma remains a public health challenge and severe asthma is the paradigm of uncontrolled and costly asthma. This first work suggests that a large-scale study be carried out for a better knowledge of it.

关键词： Asthma Children Pediatric Intensive Care CHU Brazzaville

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

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Open Journal of Pediatrics 2020年第2期10卷 255-262页

作者： Lucie Charlotte Ollandzobo Ikobo Roland Bienvenu Ossibi Ibara Neli Yvette Ngakengni Laren Babomi gaston ekouya bowassa Linda Tchidjo Ngamo Steve Vassili Missambou Mandilou Sabrina Nadia Bouithy Evrard Romaric Nika Jean Robert Mabiala Babela Faculty of Health Sciences Marien Ngouabi University of Brazzaville Brazzaville Republic of Congo Pediatric Services Brazzaville University Hospital Brazzaville Republic of Congo Infectious Diseases Service Brazzaville University Hospital Brazzaville Republic of Congo Department of Neonatology Brazzaville University Hospital Brazzaville Republic of Congo Department of Internal Medicine and Cardiology Talangai Hospital Brazzaville Republic of Congo

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 3. 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

Rare Neonatal Digestive Surgical Emergencies at the Brazzaville University Hospital Center

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Open Journal of Pediatrics 2020年第3期10卷 463-473页

作者： Lucienne Irène Patricia Ondima Caryne Mboutol-Mandavo Moïse Service Yanguedet Didace Massamba Miabaou Jean-Claude Mieret Cardinale Princilia Okiemy Niendet Gracia Christelle Ossete Peggy Dahlia Gallou Mawandza Neli Yvette Ngakengni gaston ekouya bowassa Department of Pediatric Surgery University Hospital Center Brazzaville Republic of Congo Department of Visceral Surgery University Hospital Center Brazzaville Republic of Congo Department of Intensive care and Anesthesia University Hospital Center Brazzaville Republic of Congo Department of Neonatology University Hospital Center Brazzaville Republic of Congo

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:

Late Diagnosis of HIV Infection in Children: Prevalence and Outcome

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Open Journal of Pediatrics 2017年第4期7卷 331-344页

作者： Aymar Pierre Gildas Oko Antoinette Géraldine Olandzobo gaston ekouya-bowassa Mamadou Ildevert Cyriaque Ndjobo Lucie Ollandzobo Nelly Pandzou-Guembo Letitia Lombet Jeysse Pierre Yoleine Poathy Steve Vassili Missambou-Mandilou Aurore Mbika-Cardorelle Georges Marius Moyen Department of Pediatrics Teaching Hospital Center (THC) of Brazzaville Brazzaville Congo Faculty of Health Sciences Marien Ngouabi University of Brazzaville Brazzaville Congo Hospital Center of Loandjili Pointe-Noire Congo

Background: Late diagnosis of HIV infection is an important cause of death in children. Objectives: To determine the prevalence of late diagnosed HIV infection in children, describe the socio-demographic characteristics and to analyze outcome of these children. Methods: From January 2015 to October 2016, we carried out a prospective analytical study in the pediatric departments of University Teaching Hospital of the Brazzaville. Late diagnosed HIV children were selected for this work. Data analysis was performed in univariate and multivariate with Epi Info 7.2.1. Results: Of the 6058 hospitalized children, 103 (1.7%) were selected, 57.3% were boys;the median age was 21.9 months (IQR, 17.8 - 76.7 months). Children of low socio-economic status accounted for 68.0%, those motherless: 43.7%. None of the children were tested for HIV before hospitalization. Mothers had a low education level in 60.2% of cases and were unaware of prevention of mother-to-child transmission (PMTCT): 60.3%. Children mostly showed signs of stages 4 (49.5%), and 3 (31.1%) of HIV infection, immunodeficiency was severe for 68.0% of children. Children discharged from the hospital accounted for 62.1% of which 15.53% against medical advice. The case fatality rate was 37.9%. The risk factors for death in univariate analysis were: age < 12 months (OR = 8.66), maternal death (OR = 17.93), severe malnutrition (OR = 66.07), clinical stages 4 (OR = 66.07) and severe immunodeficiency (OR = 17.37). The main pathologies responsible for death were respiratory infections (38.5%) and diarrheal diseases (30.8%). Conclusion: Improvement of PMTCT program effectiveness, universal access to early detection and antiretroviral therapy for infants are needed to reduce the number of late diagnosed HIV-children and therefore HIV-related morbidity and mortality.

关键词： Late Diagnosis HIV Infection Prevalence Mortality Child Brazzaville