Browsing by Subject "Paediatric Gastroenterology"

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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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    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.