Browsing by Author "Pillay, Shakti"

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    Quality of neonatal cranial ultrasound Interpretation among doctors in the Western Cape Metro: a clinical survey
    (2023) Belay, Fitsum; Pillay, Shakti; Horn Alan
    Background: Cranial ultrasound (cUS) is a recommended skill for paediatric and neonatal trainees in South Africa. Surveys in other countries showed inadequate knowledge and subsequently a global trend towards standards and training recommendations. There are no guidelines for training of clinicians performing cUS in South Africa. Objectives: To survey the following aspects of cUS among paediatric and neonatal trainees in the University of Cape Town (UCT): duration of paediatric training, experience and supervision; knowledge of reporting content, procedural and technical aspects; interpretation of common neonatal cUS pathologies and confidence in scan interpretation and counselling. Methods: An online survey was sent to all trainees, who had worked at least one month at a neonatal unit on the UCT training platform. The survey included seven questions on cUS interpretation. Procedural and image knowledge was compared between groups with ≥ 24 months' experience versus shorter duration. Results: Thirty-one paediatric registrars and five neonatal subspecialty senior registrars were sent the survey. Twenty-six surveys were returned (72%). None of the trainees had attended a formal cUS course, 18 (69%) had attended a formal lecture from a neonatologist, and 8 (30%) had attended a formal tutorial from a consultant. Ten (38%) trainees received initial training from other registrars, medical officers, or self-study. The components of a cUS report were stated as description of anatomy and haemorrhage by 24 (92%) and 21 (81%) respectively; only 17 (65%) mentioned ventricular size and other aspects of reporting were less frequently mentioned. Only 7 (27%) trainees knew the correct number of images to be taken in the coronal and sagittal planes. Correct identification of the major features of images ranged from 12% to 92% but was below 40% in five questions. Duration of training only affected answers in two questions; trainees with ≥ 24 months experience were more likely to correctly identify a normal scan (58% vs. 14%; p=0.038) and less likely to assign abnormal prognosis in a term infant with increased white matter echogenicity (0% vs. 43%; p=0.017). Conclusions: Our survey shows inadequate and variable cUS training and competency in paediatric and neonatal trainees in our institution. The findings indicate the need for a structured training program and standardised diagnostic and training criteria to accredit clinicians who perform and report on neonatal cUS.
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    Open Access
    Symptomatic congenital syphilis in a tertiary neonatal unit: a retrospective descriptive study
    (2016) Pillay, Shakti; Tooke, Lloyd
    Background: Syphilis is a disease that was first described in the 1300s and now 700 years later, despite preventive measures and effective treatment, continues to impact on a global scale, with the burden falling largely on the developing world. We could find no recent published literature looking at predictors of outcomes in neonates born with symptomatic congenital syphilis, especially in the context of a tertiary neonatal setting. Methodology: The study design was a retrospective descriptive folder review of neonates born with symptomatic congenital syphilis at Groote Schuur Hospital (GSH) from January 2011 to December 2013. One of the primary objectives was to address outcome as well as look at modifiable preventable factors. All neonates treated at GSH (inborn and outborn) who tested serologically positive for syphilis together with clinical signs of syphilis were included. Data was obtained from the National Health Laboratory System (NHLS) database, as well as the notification and death registers at GSH nursery. All data was collected in a Microsoft excel spread sheet and analysed using Microsoft StatPlus. Results: Fifty of eighty neonates (62.5%) with positive syphilis serology as well as clinical signs of congenital syphilis were included together with their fifty mothers. The majority (98%) of mothers were inadequately untreated. Nineteen neonates demised. There were no statistically significant differences between the deaths and survivors in terms of gestational age (p = 0.15), birth weight (p = 0.08) or maternal age (p = 0.51). Two significant predictors of mortality were one minute and five minute Apgar scores of less than five ([RR], 3.5; 95% CI 1.6-7.7 and [RR], 2.9; 95% CI 1.5-5.3 respectively). Hydropic neonates, tended to be sicker at birth, requiring intubation and inotropes, which was associated with a poorer outcome (increased risk of mortality). Conclusion: Despite the introduction of a National Syphilis Screening programme more than twenty years ago together with a large proportion of pregnant women having access to antenatal care, congenital syphilis is still prevalent in South Africa. Failure to access antenatal care, poor partner tracing and a number of modifiable health worker related failures contribute to poor maternal diagnosis and treatment. Many neonates with congenital syphilis require aggressive interventions and there is a high mortality rate. This dissertation adds to the existing body of research particularly with regard to predictors of outcome in tertiary neonatal settings. Certain categories of neonates have a lower survival rate and guidelines about limitation of care may need to be considered in order to optimise resource allocation particularly in resource-constrained settings. Further research is required to elaborate how best to develop protocols in these neonates.