Browsing by Author "Goddard, E"

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    Determining the prevalence of malnutritionin hospitalised paediatric patients
    (2006) Marino, L V; Goddard, E; Workman, L
    Aim. To determine the prevalence of malnutrition in hospitalised paediatric patients at Red Cross War Memorial Children’s Hospital. Method. A 1-day cross-sectional survey was completed in all medical and surgical wards and some specialist outpatient clinics. Results. A total of 227 children participated in the study. Thirty-five per cent of patients were moderately malnourished (b -2 z-score), of whom 70% had no road to health card with them. Thirty-four per cent of children under 60 months of age received supplements in addition to a normal ward diet, 7.8% were enterally fed and less than 1% were parenterally fed. Almost 14% of children were found to be overweight/ obese, which is higher than the national average of 6%. The prevalence of HIV infection on the day of the audit was 18% across all age groups compared with the Western Cape antenatal prevalence of 15.7% (2005). Conclusion. The overall prevalence of undernutrition was 34%, which is comparable with similar studies. However, the proportion of overweight children (14%) was greater than the national average. In view of the level of malnutrition seen, a nutrition risk-screening tool, identifying risk factors for malnutrition such as food access and vulnerability, should be developed. The tool should be used to assess nutrition status and risk during the course of hospitalisation, in addition to planning appropriate nutrition care plan interventions for discharge.
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    Liver transplantation at Red Cross War Memorial Children's Hospital
    (2006) Spearman, C W N; McCulloch, M; Millar, A J W; Burger, H; Numanoglu, A; Goddard, E; Gajjar, P; Davies, C; Muller, E; McCurdie, FJ; Kemm, D; Cywes, S; Rode, H; Kahn, D
    The liver transplant programme for infants and children at Red Cross War Memorial Children’s Hospital is the only established paediatric service in sub-Saharan Africa. Referrals for liver transplant assessment come from most provinces within South Africa as well as neighbouring countries. Patients and methods. Since 1987, 81 children (range 6 months - 14 years) have had 84 liver transplants with biliary atresia being the most frequent diagnosis. The indications for transplantation include biliary atresia (48), metabolic (7), fulminant hepatic failure (10), redo transplants (3) and other (16). Four combined liver/kidney transplants have been performed. Fifty-three were reduced-size transplants with donor/recipient weight ratios ranging from 2:1 to 11:1 and 32 children weighed less than 10 kg. Results. Sixty patients (74%) survived 3 months - 14 years post transplant. Overall cumulative 1- and 5-year patient survival figures are 79% and 70% respectively. However, with the introduction of prophylactic intravenous ganciclovir and the exclusion of hepatitis B virus (HBV) IgG core Ab-positive donors, the 1-year patient survival is 90% and the projected 5-year paediatric survival is > 80%. Early (< 1 month) postliver-transplant mortality was low. Causes include primary malfunction (1), inferior vena cava thrombosis (1), bleeding oesophageal ulcer (1), sepsis (1) and cerebral oedema (1). Late morbidity and mortality was mainly due to infections: de novo hepatitis B (5 patients, 2 deaths), Epstein-Barr virus (EBV)- related post-transplantation lymphoproliferative disease (12 patients, 7 deaths) and cytomegalovirus (CMV) disease (10 patients, 5 deaths). Tuberculosis (TB) treatment in 3 patients was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1). Conclusion. Despite limited resources, a successful paediatric programme has been established with good patient and graft survival figures and excellent quality of life. Shortage of donors because of infection with HBV and human immunodeficiency virus (HIV) leads to significant waiting-list mortality and infrequent transplantation.
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    Prevalence of bacterial contamination of powdered infant feeds in a hospital enviroment
    (2007) Marino, L V; Goddard, E; Whitelaw, A; Workman, L
    Background. The study arose as part of a best-practice nutrition model regarding the introduction of ready-to-use (RTU) infant feeds in place of powdered infant feeds (PIFs) as a standard formula for infants under the age of 1 year who are unable to be breastfed. Internationally and locally there is grave concern regarding the safety and efficacy of mixing PIFs, especially in a hospital setting, and the resultant bacterial contamination causing enteric infections, especially in premature, immunocompromised and sick infants. Objective. To evaluate the prevalence of bacterial contamination of PIFs given to infants at Red Cross War Memorial Children’s Hospital, Cape Town. Methods. Quantitative levels of bacterial contamination were determined and were expressed as colony-forming units (CFUs) per millilitre of sample. Aliquots of milk were inoculated onto agar, and the milk samples were then incubated at 25o C overnight (N = 10), 30o C overnight (N = 48) and 30o C for 6 hours (N = 34). Post-incubation milk samples were cultured again. Contamination was defined as any positive culture before administration (i.e. pre incubation) or > 102 CFU/ ml after administration (i.e. post incubation). Results. Fifty samples of PIFs (N = 82) were contaminated pre incubation, with 25/82 samples (30.4%) being heavily contaminated (≥ 104 CFU/ml). Post incubation, 43/92 samples (46.7%) were contaminated with > 102 CFU/ml. The acidified PIFs appeared to have some bactericidal effect against some of the organisms, but not all. Conclusions. RTU infant feeds are sterile and are recommended for use in all hospitalised infants. The results of this study indicate that even when milk is prepared in a controlled environment there is significant bacterial contamination of PIFs post production. As RTU feeds are now readily available in South Africa every attempt should be made to use a sterile RTU system for hospitalised infants
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    Reasonability of gastro-oesophageal reflux study requests (contrast swallows and milk scans) for the detection of gastro-oesophageal reflux disease at Red Cross War Memorial Children's Hospital - a retrospective analysis
    (2015) Bau, Steffen; Goddard, E; Brink, Anita; Banderker, E
    Poor weight gain, recurrent vomiting and fussiness, chronic cough and recurrent chest infections are among the wide variety of signs that are often attributed to gastro-oesophageal reflux disease (GORD). The difficulty lies in distinguishing between physiological gastro-oesophageal reflux (GOR) and GORD and none of the tests available can, alone, give conclusive evidence for the latter. Clinicians are often at a loss which investigation to request in order to assess for GOR and assist in a diagnosis of GORD. Our hypothesis was that GORD investigations at Red Cross War Memorial Children's Hospital (RCWMCH) are requested without considering the appropriate modality required and without clear indications for suspecting GORD. This was supported by practical experience and a short preliminary review of request forms. In South Africa no specific guidelines exist regarding the diagnosis of GORD and there is a poor understanding of available tests and their role in aiding the diagnosis. Thus many unnecessary tests are requested. To review how appropriate the requests for GORD investigations were we analysed all requests made to the departments of nuclear medicine and radiology at RCWMCH for the purpose of GORD investigation between January and April 2011. This analysis was based on a review of the folders and the data of tests performed on all included patients. The two examination modalities involved were gastro-oesophageal radionuclide scintigrams (commonly known as milk scans) and contrast swallows. The specific points assessed were reasonability of the request, appropriate timing of the investigation, use of the correct modality for the question investigated and lastly evaluation of prior treatment with antacids. We found that most of the studies performed were requested on appropriate grounds and that the timing of the majority of the investigations was reasonable.