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Epidemiology of Admissions in a Pediatric Emergency Department in Albert Royer Hospital Dakar

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Open Journal of Pediatrics 2022年第1期12卷 188-195页

作者： Aliou Thiongane Aliou Abdoulaye Ndongo Amadou Sow Younoussa Keita Djibril Boiro yaye joor dieng Idrissa Basse Ndiogou Seck Lisimo Abwa Hilaire Papa Moctar Faye Amadou Lamine Fall Assane Sylla Saliou Diouf Ousmane Ndiaye Centre Hospitalier National d’Enfants Albert Royer Dakar Sénégal Service de pédiatrie Hô pital Le Dantec Dakar Sénégal Service de pédiatrie Hô pital Abass ndao Dakar Sénégal Centre Hospitalier National d’Enfants de Diamniadio Dakar Sénégal Service de pédiatrie Hô pital régional Saint Louis Sénégal Service de pédiatrie Hô pital Dalal Jamm Dakar Sénégal

Background: Pediatric emergencies are a public health priority in Senegal. The objective was to describe the epidemiology of admissions to the emergency department of the Albert Royer National Children’s Hospital in Dakar, Senegal. Methods: Prospective, descriptive and analytical study over a period of 4 months (January-April 2020). The study population was children admitted for vital distress. Results: A total of 300 children met the inclusion criteria and represented the study population (2.83%). The majority (70.67%) were younger than 60 months, compared with 2.00% of newborns. Boys represented 53.8%, sex ratio 1.16. A proportion of 35.1% was referred. More than half of our patients (55.88%) were managed within 30 minutes of arrival. Medicalized transport concerned 21.5% against 78.5% of nonmedicalized. Emergencies were dominated by respiratory distress (56.33%), dehydration (29%) and shock (13.33%). We recorded 16 deaths (5.3%). This mortality was significantly related to the low socio-economic level (p = 0.000), as well as the young age of the children (p = 0.01). Conclusion: Life-threatening emergencies are frequent and responsible for significant lethality. Health policy efforts are still needed to reduce this infant and child morbidity and mortality.

关键词： Children Emergencies Morbidity Mortality

Descriptive and Analytical Study of Factors Associated with Mortality in Severe Malaria among Children in Dakar Emergency Departments from July to December 2022

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Open Journal of Pediatrics 2023年第6期13卷 866-878页

作者： Aliou Thiongane Abou Ba Fatou Ly Aliou A. Ndongo Djibril Boiro Younoussa Kéita Idrissa Basse Babacar Niang Indou Dême Ly yaye joor dieng Djenaba Fafa Cissé Ndiogou Seck Lamine Thiam Papa Moctar Faye Amadou Lamine Fall Assane Sylla Ousmane Ndiaye Centre Hospitalier National d’Enfants Albert Royer Dakar Sénégal Service de pédiatrie Hô pital Dalal Jamm Dakar Sénégal Service de pédiatrie Hô pital Pikine Dakar Sénégal Service de pédiatrie Hô pital Abass Ndao Dakar Sénégal Centre Hospitalier National d’Enfants de Diamniadio Dakar Sénégal Service de pédiatrie Hô pital régional Saint Louis Sénégal Service de pédiatrie Hô pital de la paix de Ziguinchor Ziguinchor Sénégal

Background: Malaria is the most widespread parasitic disease and remains a public health priority worldwide. The severe form is fatal if not treated early and appropriately. The aim was to carry out a descriptive and analytical study of the factors associated with mortality during severe malaria in children attending emergency departments in Dakar, Senegal. Methods: This is a prospective, observational and analytical study conducted over a 6-month period (July 1 to December 31, 2022), focusing on children hospitalized for severe malaria according to WHO severity criteria. Results: A total of 403 patients were hospitalized, including 78 cases of severe malaria (19.35%). Males predominated (60.26%) (sex ratio 1.51). The average age was 6.56 years [8 months - 14 years], with the [5 - 10 years] age group the most represented (40.26%). The average consultation time was 5.33 days (1 - 19 days). The main reasons for consultation were fever (70.51%), vomiting (24.35%) and convulsions (14.10%). Biological signs of severity were severe anemia (17.95%), renal failure (6.4%) and hypoglycemia (3.85%). Thrombocytopenia was noted in 52.56% of patients, including 32.05% of severe cases (sis in 61.41% of cases. Hyponatremia was noted in 39.74% of cases and hyperkalemia in 2 patients. Artesunate was the main drug used (93.59% of cases). Mortality was estimated at 1.5%. Factors leading to death were coma (P < 0.01), respiratory distress (P Conclusion: Malaria is still a public health problem, with a high mortality rate in emergency departments. Reducing this mortality rate requires effective management of the factors associated with death.

关键词： Children Malaria Death Factors

Acute Bilirubin Encephalopathy: A Propos of 151 Cases Collected during a Multicentric Study in Senegal

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Open Journal of Pediatrics 2023年第1期13卷 50-62页

作者： Serigne Tawa Ndiaye yaye joor K. B. dieng Papa Moctar Faye Mohameth Mbodj Sofietou Dieye Khadim Bop Papa Souley Sow Amadou Sow Ndeye Fatou Sow Ibrahima Diop Aziz Faye Sadio Konate Ibrahima Diagne Mousatapha Ndiaye Ousmane Ndiaye Centre Hospitalier National D’Enfants Albert Royer Dakar Senegal Centre Hospitalier Municipal Abass Ndao Dakar Senegal Gaston Berger University Saint Louis Senegal Cheikh Anta Diop University Dakar Senegal

Introduction: Bilirubin encephalopathy is a debilitating complication of severe neonatal unconjugated bilirubin jaundice. The aim of this study was to determine the frequency of occurrence of this complication and to describe the diagnostic and prognostic aspects in Senegal. Materials and Methods: This was a multicenter, descriptive and analytical study conducted in 32 neonatal units of various levels, with retrospective (January to December 2020) and prospective (January to August 2021) collection. All neonates hospitalized for acute bilirubin encephalopathy were included. The diagnostic criteria were the presence of jaundice associated with neurological signs (muscle tone disorders, abnormal movements, convulsions, etc.), with no other obvious etiology found. The data were entered and analyzed using SPSS version 23 software. The significance threshold was retained for a p-value Results: We registered 151 patients. The mean age was 6 days and the sex ratio was 2.5 (clear male predominance). The majority of newborns were from Dakar (51%). Twenty-two (22%) were premature and 32% had low birth weight. Half of the newborns (50%) came from home and 87% were exclusively breastfed. The average time to consult was 3 days. Neurological signs were dominated by decreased primitive reflexes (74%), abnormal movements (59%) and lethargy (50%). Dehydration (30%) and anemia (26%) were often associated. The mean bilirubin level was 416 umol/l. Neonatal infections (19%) and Rhesus (16.7%) and ABO (8.7) incompatibility were the main causes. One third (33%) of patients had received intensive phototherapy and only 2% had received exchange blood transfusion. The case fatality was 48.9%. Conclusion: Bilirubin encephalopathy remains a major concern in Senegal. It is associated with high mortality and numerous neurological sequelae. Progress in terms of early detection and appropriate management is urgently needed on a national scale.

关键词： Icterus Encephalopathy Phototherapy Lethality

Metabolic Emergencies in Newborns in a Subsaharian Neonatology Department: Evaluation of Glucose, Sodium and Potassium Disorders

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Open Journal of Pediatrics 2022年第1期12卷 263-273页

作者： Ndèye Fatou Sow Amadou Sow Mame Aita Seck Yaay joor dieng Djeneba Fafa Cissé Papa Moctar Faye Ndèye Ramatoulaye Diagne Ousmane Ndiaye Department of Pediatrics National Children’s Center Albert Royer Dakar Sénégal

Introduction: Metabolic neonatal adaptation is a complex phenomenon and metabolic disorders can be frequent in immature newborns or in life-threatening situations. In Low and Middle income countries (LMIC) the difficult access to some diagnostic tests makes the management of the metabolic emergencies challenging. The main objectives of this study were to assess the frequency and circumstances of occurrence and to describe the clinical picture associated with glucose, sodium and potassium disorders in neonates. Patients and Methods: Our study was a retrospective and descriptive study conducted in the neonatology unit of National Children Hospital Albert Royer in Dakar (Senegal) from January 1 to December 31, 2014. Results: The prevalence of the studied metabolic disorders was 46.7%. The most common metabolic disorder noted was Hyperglycemia followed by Hyponatremia. Thermoregulation disturbances were found particularly in newborns with serum sodium disorders (hyponatremia 33.5% and hypernatremia 59.7%). Neurological signs were noted in case of blood sugar abnormalities (hypoglycemia 26.1% and hyperglycemia 29.8%). Half of the newborns with hyperglycemia (82 cases/50%) had blood sugar levels greater than or equal to 2 g/l. Hypernatremia was severe (Serum sodium> 180 mmol/l) in 12 neonates (16.7%). The main diagnoses retained were sepsis (159 cases/45.4%), prematurity (96 cases/27.4%), intrauterine growth retardation (66 cases/18.9%), malformations (63 cases/18%), perinatal asphyxia (44 cases/12.6%) and malnutrition (36 cases/10.3%). For most metabolic disorders, the correction was late and was done beyond 48 hours. On average, the correction time varied between 3 hours and 6 days. The most frequent complications were cerebral edema (12 cases), brain death (8 cases) and increased intracranial pressure (3 cases). The most lethal disorders were Hyperkalemia followed by Hyperglycemia. Conclusion: Metabolic disorders especially glucose, sodium and potassium disorders are c

关键词： Metabolic Disorders Newborn Hypoglycemia Hyperkalaemia Hyperglyce-mia Hypernatremia

Primary Immune Deficiencies (PID): Diagnosis Challenges

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Open Journal of Pediatrics 2021年第3期11卷 388-392页

作者： Indou Deme/ly Awa Kane Mame Sokhna Gueye Ibrahima Diop Mame Tene Ndiaye Abou Ba Idrissa Demba Ba Babacar Niang Aliou Thiongane Yaay joor dieng yaye Fatou Mbodj/Diop Ouafae Achnin Papa Moctar Faye Amadou Lamine Fall Ibrahima Diagne Tandakha Ndiaye Dièye Ousmane Ndiaye Albert Royer National Children’s Hospital Center Université Cheikh Anta Diop Dakar Senegal National Blood Transfusion Center Dakar Senegal Health Science Unit Gaston Berger University Saint -Louis Senegal

Background: Primary Immune Deficiencies (PID) are rare, under-determined diseases particularly in sub-Saharan Africa. The diagnosis is often suspected with uncommon clinical signs. Infections are the main diagnostic circumstances in infants. Confirmation is often difficult because some additional examinations are unavailable in many of our countries. Aim: Our aim was to share the challenge of diagnosis and treatment in PID. Case Presentation: It is about two infants, a boy and a girl, with early several infections. Both of them presented a hypo-gammaglobulinemia and to the boy, the immuno-phenotyping lymphocyte showed a decreased level of lymphocytes CD19. We are looking for genetic confirmation but it is not easy. The treatment of these infants requires a substitution for life of immunoglobulin which is unavailable in our countries. Conclusion: PID are suspected with atypical clinical signs. Confirmation genetic diagnosis is difficult in low income countries. To improve the follow up, we need to strengthen clinical-biological collaboration.

关键词： Primary Immune Deficiencies Hypo-Gammaglobulinemia Infants

Malaria Characteristics in Children with Sickle Cell Disease

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Open Journal of Pediatrics 2022年第1期12卷 125-130页

作者： Indou Deme/Ly Cheikh Binetou Fall Awa Kane Ibrahima Diop Aminata Mbaye Yaaye joor dieng Denika Estelle Liapoui Idrissa Demba Ba Abou Ba Aliou Thiongane Papa Moctar Faye Amadou Lamine Fall Ibrahima Diagne Ousmane Ndiaye Cheikh Anta Diop University Dakar Senegal Gaston Berger University Saint-Louis Senegal

Background: The relationship between sickle cell disease and malaria is the subject of much controversy. However, there is a lack of data in our services. Our objective was to study the epidemiological, diagnostic and evolutionary characteristics of malaria in children with sickle cell disease followed in a specialized setting. Patients and Methods: We conducted a retrospective, descriptive, and analytical study of children with sickle cell disease (SCD) who presented with malaria and were followed at the Ambulatory Care Unit for Sickle Cell Children and Adolescents (USAD) at the Albert Royer National Children’s Hospital in Dakar, from January 1st, 2017, to December 31th, 2019. We included all the followed pediatric patients, less than 16 years, with sickle cell disease who presented at least one episode of malaria, confirmed by a positive thick drop, during this 3 years. We did not include patients with incomplete records or those older than 16 years. The clinical and biological signs, the follow up was collected and analyzed with Excel package 2019. Results: Of 3773 patients followed for sickle cell disease, 21 had presented malaria. The frequency was 0.5% or 7 cases/year. However, we exploited the data of 14 of them. The sex ratio was 6 boys for a girl and the mean age at admission was 7.3 years. The highest number of malaria cases was observed in 2018 and the peak frequency was observed in November with 8 cases (57.1%). Fever was the most frequent symptom, observed in 10 patients (71.4%). All patients were SS homozygous, with a mean baseline hemoglobin level of 7.5g/dl. All patients had a positive thick blood smear and Plasmodium falciparum was the only species found in the blood smear, with a mean parasite density of 1693 parasites/ml of blood. All patients had anemia, with a mean hemoglobin level of 7.74 g/dl. Twelve patients (85.7%) were hospitalized and had all received injectable artesunate followed by oral Artemisinin Combination Ther

关键词： Malaria Sickle Cell Disease Children

Evolutionary Profile of Graves’ Disease in Children at Albert Royer National Children Hospital in Dakar

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Open Journal of Pediatrics 2019年第2期9卷 119-125页

作者： Babacar Niang Lamine Thiam Fatou Ly Indou Dème Ly Djibril Boiro Amadou Sow Aliou Thiongane Aliou Abdoulaye Ndongo Aminata Mbaye Younoussa Keita Abou Ba Idrissa Demba Ba Yaay joor dieng Dienaba Fafa Cissé Papa Matar Faye Amadou Lamine Fall Ousmane Ndiaye Albert Royer National Children Hospital Center Dakar Senegal La Paix Hospital Ziguinchor Senegal Pediatric Ward University Hospital Center of Pikine Dakar Senegal Pediatric Ward University Hospital Center of Abass Ndao Dakar Senegal Pediatric Ward University Hospital Center of Aristide Le Dantec Dakar Senegal

Graves’ disease is the most common cause of hyperthyroidism. Adequate management is an area of controversy, especially when it comes to children. The objective of our study was to assess the outcome of Graves’ disease treatment in Albert Royer Children Hospital of Dakar. This was a retrospective study conducted from 2001 to 2015, and which involved all children between 0 to 15 years of age who were being monitored in the Albert Royer National Children Hospital. The evolutionary modalities were: stability, remission, failure, relapse, lost to follow-up and death. The data were analyzed with SPSS software version 20.0. For the comparisons, the KHI 2 or Fisher test was used with a significance threshold (p < 0.05). During the study period, 88 children were enrolled. The average age was 8.6 years [ranging from 8 months to 15 years]. The consultation delay was 11.36 months. In our study, 61.4% of the patients were regular in the follow-up, the observance was good in 40.9% of the cases and 19 patients (21.6%) were lost to follow-up. Clinical courses of 69 children after treatment with Carbimazole for 37 months were promising in 21 cases (30.43%), with 17 cases of remission (24.63%) and 4 cases of stability (5.8%). Age older than 10, the initial ATD dose greater than 1 mg/kg/day and the initial free T4 lower than 50 pmol/l were significantly associated with remission with a p value of 0.01;0.024 and 0.004.

关键词： Graves’ Disease Child Antithyroid Drug Remission Senegal