Tuesday, January 9, 2018

Childbirth conditions defining future growth


By Keneth Kammu kenethkammu@gmail.com

During a ward round at the hospital last week, I came across a one year and six months old boy who, at that age, was incapable of controlling his neck and head.

It dawned on me that something wasn’t right, and perhaps, this had to do with a long history of how the boy developed.

I also realised that he was unable to sit unless supported by his mother on the bed beside. He could neither stand nor walk, although by that age, he should have been able to do so.

The first impression I got, as I tried to analyse his condition was: “He has delayed developmental milestones.” However, I had to delve into the details of his progress since birth.

Tracing the problem

As I tried to obtain a brief history from his mother, I was informed that on the day the boy was born, he did not cry immediately; like other new born children do.

Usually, if the new-born baby does not cry immediately after birth, it signals something that needs closer follow up, monitoring or rather closer attention.

In this case, I was told that, as a new-born baby, the boy “cried two hours later,” after delivery. Apart from that, I learnt that he was admitted for four days at the hospital after birth. Why?

He had what we call neonatal jaundice—a liver condition that causes yellowing of a new-born baby’s skin and eyes.

But, he was also found to have hypoglycaemia (low blood sugar) for 2 weeks in hospital. That was his history at birth.

Well, last week, when I examined him, one diagnosis stood out—cerebral palsy (CP)—a permanent disorder of posture and movement that results to activity limitation.

Who can suffer from CP?

It is important to know that CP does not just happen. Depending on what happened around the child during pregnancy, childbirth and 28 days after delivery, it can be determined whether the born child will develop cerebral palsy or not.

These are the conditions to watch out during pregnancy: Sexually Transmitted Infections (STIs), HIV/AIDs, conditions linked to high blood pressure such as preeclampsia and eclampsia.

This also includes defects of the placenta which may impair the transfer of nutrients and gaseous exchange between the mother and foetus.

Cases of CP have also been reported among women who abuse drugs during pregnancy.

There is a risk of premature delivery which often leads to low birth weight, low blood glucose level and neonatal jaundice, conditions that may account for cerebral palsy. After delivery, inability to breathe, inflammatory conditions like encephalitis and meningitis, seizures, any birth trauma may lead to cerebral palsy.

With this piece of information, I would like call upon women to always abide by simple preventive measures such as screening for Venereal diseases, HIV/AIDs and attending regular for clinic as scheduled when they are pregnant.

These are among the ways they can be able to monitor for safe and health delivery.

Our role as medical practitioners

On the other hand, it’s our role as medical practitioners to pay close attention during the childbirth so that we can do away with circumstances that can lead to CP.

Children with CP in our country have been a burden as most of families are facing economic hardships.

This means that most of the families fail to take care of the children, in terms of treatment and psychosocial support.

These children are part of the society we live in, unlike people who never think the opposite of this.

I know institutions that have instituted key interventions. The Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) has played a big role in dealing with such disabilities.

This is where the rights of the affected are protected; by assuring affordable quality medical and rehabilitative services, educating the community on the rights of disabled, together with facilitating the disabled to live their full potential.