BackgroundIn sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) is unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury.MethodsInfants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36h reported blind to NE status.ResultsScans were performed at median age 11.5 (IQR 5.2-20.2) and 8.4 (IQR 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of cases vs 1.0% controls (p<0.001). White matter injury was not significantly associated with bacteraemia in encephalopathic infants (OR 3.06 (95%CI 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs 25.9% without; OR 3.34(95%CI, 1.61-6.95)).ConclusionsIn this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischaemia. Early abnormalities were a significant predictor of death.

In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) is unknown. Aim To evaluate cranial ultrasound (cUS) scans from term Ugandan infants with NE and unaffected controls for evidence of established/evolving brain injury. Methods Infants were recruited to a case-control study at Mulago Hospital, Kampala. Cases had NE (score1 >5). Controls were randomly selected unaffected term infants. All had cUS scans <36 h; surviving cases had day 4/5 scans. Minimally 11 views were reported blind to NE status. Scan injury definitions were evolving: extensive white matter (WM) and/or bilateral basal ganglia-thalamic (BGT) echogenicity and established: parenchymal cysts, atrophy, organising haemorrhage. Results Early scans showed significant abnormality in 20.4% (35/172) cases vs 1.0%(1/99) controls (p < 0.0001, mean age 11.2 h/8.1 h, respectively). Case scans at <18 h (120) still showed a high prevalence of abnormalities (16.7%). Case infants had 9.3% WM injury alone, 6.4% BGT injury alone and 4.7% BGT/WM injury. No established injury was seen. Fatality was significantly higher in cases with early cUS abnormalities vs those without (57.1%(20/35) vs 25.9%(35/135); OR 3.81(95% CI 1.76–8.25)). Serial scans were done in 88 mostly surviving NE infants; 74 had normal early scans with 35(47.3%) becoming abnormal by day 4/5. Conclusions The high proportion of infants with early cUS abnormality plus absence of established antepartum injury implies the injury pathway often begins several hours before delivery in this population, with implications for therapeutic interventions considered effective early in the injury pathway. Early cUS abnormality in NE was a significant predictor for death. References Thompson, et al. Acta Paediatr 1997 van Wezel-Meijler, et al. Neuropediatrics 2007

Objectives: We sought to understand the facilitators and barriers impacting utilisation of follow-up services for children born preterm as perceived by parents in a lowresource setting. Methods: We conducted a qualitative study at Mulago Hospital, Uganda, with parents of children born preterm and aged 22-38 months at the time of the study. We collected data using five in-depth interviews and four focus group discussions. Data were analysed using thematic analysis informed by the social-ecological model. Results: Ten subthemes emerged that could be grouped into three main themes:(1) Individual: parents' knowledge, parenting skills, perception of follow-up and infant's condition; (2) Relationship: support for the mother and information sharing;(3) Institution: facility setup, cost of care, available personnel and distance from the facility. Parents of preterm infants perceived receiving timely information, better understanding of prematurity and its complications, support from spouses, availability of free services and encouragement from health workers as facilitators for utilisation of follow-up services. Limited male involvement, parents' negative perception of follow-up, stable condition of infant, health facility challenges especially congestion at the hospital, distance and care costs were key barriers. Conclusion: An interplay of facilitators and barriers at individual, interpersonal and health system levels encourage or deter parents from taking their preterm children for follow-up services. Improving utilisation of services will require educating parents on the importance of follow-up even when children are not sick, eliciting maternal support from spouses and peers and addressing health system gaps that make follow-up unattractive and costly.

Introduction Advances in neonatal care have led to the increasing survival of preterm/low birth weight infants worldwide. However, there is limited data on growth outcomes following preterm births especially in low and middle income countries. We assessed the catch-up growth, nutritional status and associated factors of Ugandan children who were born preterm/ low birth weight at Mulago National Referral Hospital.Methods: We enrolled children aged 22-38 months who had been born as preterm with low birth weight and their mothers. Participants were identified and recruited from the follow up clinic for preterm babies discharged from the neonatal unit of Mulago Hospital. Anthropometric measurements for mothers and children were taken. The children’s weight for height z-scores, height for age z-scores, weight for age z-scores, head circumference and mid upper arm circumference (MUAC) were taken and the mothers’ body mass index were generated based on the World Health Organization standards. Results: Of the 251 children and mother pairs recruited, 129 children (51.4%) were male, the mean age was 29.7 months (SD±4.5) and the mean maternal age was 29.9 (SD±5.3). 101(40.1%) of the children enrolled had attained catch up growth on the normal anthropometric measurements for their age. Among the participants, the prevalence of wasting, underweight and stunting was: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. Factors associated with stunting were male sex (AOR 2.36, 95% CI 1.42 to 3.95); p=0.001), maternal age ≤ 25years: AOR 2.27 (95%CI 1.13, 4.52); p= 0.020, and maternal height <150cm: AOR 5.57(95%CI 1.90, 16.94); P=0.002. Associations with underweight in the children were; birth weight ≤1500 gms: AOR 2.38(95%CI 1.14, 4.95); p=0.020 and post-natal hospitalization of more than 14 days: AOR 5.93(95%CI 1.96, 17.90); p=0.002. For 246 (98.8%) participants, MUAC was normal (≥ 12.5 cm) and for 216 (86.8%) the head circumference was within normal range for age.Conclusion: Of the children born preterm/LBW 40.1% of the participants had attained the expected catch up growth at 2 to 3 years of age, 42.2% were observed to be stunted while 14.4% were underweight both higher than the national levels. Targeted interventions are specifically needed for children born with very low birth weight, those requiring long postnatal hospitalization, males and those born to short or young mothers.

Background: Follow up after hospital discharge is a recommended and common medical practice for high risk infants like those born with low birthweight and at preterm, this however is rare in LIC. Premature babies are at risk of long term disabilities and require continued care both at home and in designated facilities. We sought to determine the attendance of scheduled follow up clinic visits for preterm infants post hospital discharge. Methods: A review of records for all infants seen in the preterm clinic at Mulago National Referral Hospital between January and December 2015 was done. After discharge from the SCBU, infants are followed up in the Kangaroo Mother Care clinic every fortnight until they weigh 2500 grams. They then transition to the Preterm Care Clinic where they are followed up every two to three months until 18 months of corrected age. Findings: Between September 2014 and December 2015, 7224 neonates were admitted to the SCU of Mulago Hospital. Of these, 3537 (49 %) weighed less or equal to 2500 grams, thus majority were eligible for follow up in the special clinics after discharge. Of the 590 babies registered in the PTC during 2016; 423 (71.7%) were included for analysis and 167 (28.3) % were excluded due to missing or incomplete data. Majority of the infants weighed 1501-2000gms (50%), only 3% weighed less than 1000gms, 14% more than 2000gms and 5% record of birth weight was missing. Almost 90% of the visits during KMC clinic were on schedule as compared to 64% during PTC visits. The average number of visits in the KMC clinic were three per baby; 105 babies had between 4-5 visits and 15% of all the participants were still attending the clinic by one year of age. Many babies were not seen in the clinic after the age of 6 months. Conclusion: Scheduled follow up clinic attendance for low birth weight preterm infants is suboptimal with only one out of four were followed up after one year. There is need to strengthen utilization of available services, community support and devise means to improve the long term follow up.