Browsing by Author "de Lacy, Ronalda"

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    A retrospective review of acute liver failure in children admitted at Red Cross War Memorial Children's Hospital
    (2021) Mlotha-Mitole, Rachel; Goddard, Elizabeth; de Lacy, Ronalda
    Acute liver failure (ALF) describes a clinical syndrome resulting from severe liver damage and extensive loss of functional parenchymal liver mass triggered by various factors. Early recognition and initiation of specific therapy may improve outcomes and reduce the need for liver transplantation, a treatment modality not universally available in resource constraint areas. There is paucity of data describing this syndrome in Sub-Saharan Africa in children. Objective This study aims to retrospectively review and determine the clinical presentation, aetiology, complications & outcome of ALF in children admitted at the Red Cross War Memorial Children's Hospital (RCWMCH). Methods All records of children from 0 to 13 years admitted at the RCWMCH over the period from January 2005 to December 2016 with ALF were retrospectively reviewed, after obtaining ethical approval. Patients with pre-existing evidence of chronic liver disease were excluded. Demographic variables as well as clinical presentation and investigations were captured, with determination of outcomes at 3 weeks and 6 weeks of diagnosis. Results Study included 24 children., 16 females (66.7%) and 8 males (33.3%). Median Age was 15 months, with interquartile range from 5 to 28 months. Diarrhoea, jaundice, respiratory distress, hepatomegaly and encephalopathy were common clinical features. Aetiology was infection in 37.5 % of cases (n=9, 2 of whom had autoimmune hepatitis comorbidity) and hepatitis A was most common infectious cause (n=4, 44%). Causes were indeterminate in 29.2%. Two patients had autoimmune hepatitis without co-morbidity; Reye syndrome 12.5% and 17% had miscellaneous causes. Transaminases were raised to thousands in viral causes of hepatitis, with a low C reactive protein. INR >4 and Total Bilirubin>210umol/L were associated with death outcome (p=0.04 and p=0.03 respectively. Conclusion Viral hepatitis A is the leading infective cause of acute liver failure in this study cohort and 29.2% of cases were indeterminable. INR >4 and Bilirubin > 210umol/l were predictors of poor outcome. Follow up study is recommended to better understand clinical spectrum and outcomes of children with acute liver failure in this low resource setting.
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    A Retrospective review of medical gastrointestinal endoscopy in children attending Red Cross War Memorial Children’s Hospital, Cape Town
    (2019) Eke, Christopher Bismarck; Goddard, Elizabeth; de Lacy, Ronalda; Brown, R A
    Background: Gastrointestinal endoscopy has evolved to become an important diagnostic, therapeutic as well as surveillance and follow-up modes of management in children with diverse gastrointestinal diseases. There is a paucity of data on gastrointestinal endoscopy in children in the sub- Saharan African region. The objectives of the study were to describe the socio-demographic characteristics; presenting symptoms; indications; endoscopic yield; impact of endoscopy on management; as well as its safety profile and complications. In addition algorithms for the indications of medical gastrointestinal endoscopy in children were designed using the results derived from the presenting symptoms and indications for gastrointestinal endoscopy among the patients. Methods: This was a cross sectional descriptive study. Subjects were children < 18 years attending Red Cross War Memorial Children’s Hospital (RCWMCH) who underwent medical gastrointestinal endoscopic procedures from 2007 to 2016. Study ethical approval was obtained from University of Cape Town while written permission from the RCWMCH Research and Management Committee prior to the commencement of the study. Data sheet was used in retrieving relevant patients variables from the hospital’s medical records and the Division of Paediatric Gastroenterology endoscopy and laboratory (histopathology) databases. Data was analysed using Stata 13.1. A p- value of less than 0.05 was considered statistically significant. Results: A total of 402 children were studied with 773 endoscopies performed comprising 670 oesophagogastroduodenoscopies (OGD) and 103 colonoscopies. For OGD: 179 (26.7%), 287(42.8%) and 204 (30.4%) procedures were for diagnostic, therapeutic and follow - up indications. A total of 78 (10.1%) combined OGD/colonoscopy were carried out. Out of 103 total colonoscopies performed, 67 (65.0%), 30(29.1%), and 6 (5.8%), were for diagnostic, follow - up and therapeutic indications respectively. vi Feeding difficulty 112 (25.4%) and rectal bleeding 11 (2.7%) were the main presenting symptoms for OGD and colonoscopy respectively. Main diagnostic indications for OGD, combined OGD/colonoscopy and colonoscopy alone respectively were chronic abdominal pain 51 (12.6%) and probable inflammatory bowel disease (IBD) 30 (7.5%) and IBD 30 (7.5%). Change 143 (35.6%)/ insertion 87(21.6%) of percutaneous gastrostomy were the most common therapeutic indications for OGD and polypectomy 8 (2.7%) for colonoscopy. Abnormal (positive) macroscopic findings on endoscopy were reported on 79/179(44.1%), 35/68(51.55%), and 46/67(53.7%) of OGD, combined OGD with lower scope, and colonoscopy alone respectively. Also, positive histological findings on OGD, combined OGD with colonoscopy, and colonoscopy alone were reported in 62/179(34.6%), 34/68(50.0%), and 32/67(47.8%) respectively. The overall normal endoscopic findings (both abnormal macroscopic findings on endoscopy and histological findings) were 63/179(35.3%) and 25/67(37.3%) for OGD and colonoscopy while overall diagnostic (endoscopic) yield was 116/179(64.8%) for OGD and 42/67(62.7%) for colonoscopy respectively. For OGD the main endoscopic yield reported were gastritis in 50(27.9%) and oesophageal varices 31(17.3%) while inflammatory bowel disease (Crohn’s disease 9(13.4%), ulcerative colitis 7(10.4%), juvenile polyps 9(13.4%) and intestinal tuberculosis 7(10.4%) were observed in colonoscopy respectively. A significant impact of endoscopy on the management of subjects were recorded in 298(74.1%) (p < 0.001) including diagnostic (change of medication, addition of new medication) and therapeutic (insertion/change of PEG; sclerotherapy 29 (9.8%) , band ligation of oesophageal varices 28 (9.4%), and polypectomy 8(2.7%)). The overall complication rate was 4.0% (16 patients). Conclusion: Feeding difficulty and rectal bleeding were the most common presenting symptoms for OGD and colonoscopy; with chronic abdominal pain and IBD being the most common indication for performing OGD and colonoscopy respectively. Therapeutic modalities of endoscopy performed were PEG insertion/change, polypectomy, sclerotherapy/band ligation for varices. vii Endoscopic yield was 116/179(64.8%) for OGD and 42/67(62.7%) for colonoscopy respectively a significant impact of endoscopy on the management of subjects were recorded in 298(74.1%) (p < 0.001). No mortalities were recorded following the procedures, however 16(4%) had some complications. Use of societal guidelines in selecting children with appropriate indications for gastrointestinal endoscopy will result in higher diagnostic yield and application of therapeutic modalities in children with gastrointestinal disorders resulting in significant impact on patient’s management and minimize complications.
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    Describing The Nutritional Outcomes Following Paediatric Liver Transplantation At A Tertiary Hospital In South Africa
    (2023) Ndhlovu, Lesego; de Lacy, Ronalda
    Background: Nutrition in chronic liver disease is an important marker of post- liver transplant outcomes in children and is monitored judiciously pre-transplantation. There is a paucity of data on post-transplant nutritional outcomes, particularly in the developing world setting. Aim: To describe the nutritional outcomes of children following liver transplantation. Methods: A retrospective study of patient's receiving post-transplant care at Red Cross War Memorial Children's Hospital in Cape Town, South Africa from 2004 – 2019. Results: 31 children were included in the analysis. Pre-transplant prevalence of stunting was 57,1%, with 32,1% of children severely stunted. At 24 months post-transplant 65,5% of children were stunted, with 44,8% severely stunted. Overweight and obesity prevalence was 0% pretransplant, and 32,2% and 27,6% at 12- and 24-months post-transplant respectively. Biliary atresia was the diagnosis in 89,5% of children with stunting at 24 months vs in 50% of children without stunting at 24 months post-transplant (p = 0.03). Mean pre-transplant albumin was lower in children with stunting at 24 months post-transplant than in children without stunting (26,7 vs 29,6 g/L respectively; p < 0,001). Age at transplant was lower in children with stunting at 24 months post-transplant vs children without stunting (40,7 versus 91,5 months; p < 0.001). Twenty-one (67,7%) children developed hypertension post-transplant. Conclusion: Stunting, hypertension and overweight/obesity are highly prevalent post paediatric liver transplantation. Lower pre-transplant albumin, younger age at transplant, and diagnosis of biliary atresia were associated with post-transplant stunting. Post-transplant growth monitoring seems prudent to prevent the development of overnutrition and associated metabolic complications.