Paediatrics- Conference Papers

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    Open Access
    Prevalence and Outcome of Higher Order Multiple Pregnancies in Lagos, Nigeria
    (BMJ Publishing group, 2012) Fajolu, I.B.; Ezeaka, V.C.; Iroha, E.O.; Egri-Okwaji, M.T.C.
    Background and Aims Higher order multiple (HOM) pregnancies are associated with higher risk of complications for both mother and babies with resultant increase in financial and psychological strain on the families. Data on outcome is essential for adequate counseling of families and positive interventions. Aim To determine the prevalence and outcome of HOM pregnancies in a tertiary hospital in Lagos, Nigeria. Methodology Data on the mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies obtained from the labor ward and theatre registers and neonatal unit records over a 3year period (April 2009–March 2012) were reviewed retrospectively. Results Seventy-four babies (45, 24 and 5 triplets, quadruplets and quintuplets respectively) were delivered from 22 HOM pregnancies out of 6521 deliveries giving a prevalence of 3.37/1000 total births. All deliveries were preterm and all the babies except 2 sets of triplets, 1 set and the 1st 2 of another set of quadruplets were delivered by caesarean section. The perinatal mortality rate was 243/1000 total births. Mortality was significantly increased with no antenatal booking (21/29 versus 5/45 for unbooked and booked pregnancies respectively, p=0.000), gestational age <30weeks (21/25 versus 5/49 for gestational age <30 weeks and >30weeks respectively, p=0.000) and birth weight < 1000g for live births (8/56 versus 10/10 for birth weight >1000gm and <1000gm respectively, p=0.000). Conclusion Proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce early preterm births and the resultant immediate poor outcomes for these pregnancies.
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    Open Access
    Precision Medicine: Molecular Diagnosis and Digital Facial Analysis Technology Applications in Congenital Cardiovascular Disorders.
    (Faculty of Clinical Sciences, College of Medicine, University of Lagos, 2018) Ekure, E.N.
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    Open Access
    Congenital Heart Malformations in Sub-Saharan Africa and Asia.
    (Wiley Periodicals, Inc., 2018-06-01) Kruszka, P.; Berger, S.; Hong, S.K.; Tanpaiboon, P.; Ekure, E.N.; Muenke, M.
    Congenital heart disease is the most common birth defect, affecting approximately 1% of all newborns. There have been multiple large studies genotyping humans with structural CHD in resource rich countries and very little study in developing nations. In this study, we focus on the genomic analysis of individuals with CHD in resource poor countries in Sub-Saharan African and Asia. Genomic evaluation of non- European individuals offers the opportunity to investigate genetic causes in different genetic backgrounds and different environmental backgrounds such as vitamin A deficiency which is endemic in Sub- Saharan Africa and parts of Asia and lower obesity rates. Clinical examination and echocardiography were used to diagnose patients with both syndromic and isolated CHD. Exome sequencing, assembly, genotyping, and annotation were performed on probands and their parents (trios) by the National Intramural Sequencing Center (NISC). DNA variant list manipulation was performed using perl scripts developed by our group and significant findings were confirmed with Sanger sequencing. Copy number variations were evaluated using both the Illumina HumanExome BeadChip-12v1_A (Illumina Inc. San Diego, CA) and the XHMM (eXome-Hidden Markov Model) software, which recovers information on CNVs from targeted exome sequence data. Selected variants are being evaluated functionally in the mouse model and zebrafish model. 124 probands have completed the pipeline including 111 parentoffspring trios and 13 probands with one parent. Currently, 60 more trios are in analysis pipeline. Probands included 83 (67%) from Sub- Saharan Africa and 41 (33%) from Asia. Tetralogy of fallot (TOF) was the most common CHD in our cohort occurring in 29 probands (23%), followed by ventricular septal defects in 27 (22%), and then pulmonary stenosis in 13 (10%). Large copy number variations were found in 19 probands (15%) with 22q11.2 deletion syndrome being most common (6%). Syndromic single gene disorders were found 11 probands (9%) with RASopathy variants found in 8 patients (6%). Three probands had pathogenic variants in genes known to cause cardiomyopathies (ACTC1, ACTN2, DSP). Novel candidate genes were chosen using a strict criterion to minimize false positive: present in two unrelated families (including families found in Genematcher and other databases), genes not known to be associated with CHD, variants not present in the ExAC database, and CADD scores greater than 15. Sixteen genes met this criteria and zebrafish evaluation is currently underway to validate pathogenicity. We have initiated the largest CHD study in a non- European cohort using next generation sequencing project to search for novel genetic associations with CHD. With 2/3 of next generation sequencing complete on our cohort, we are now finding novel genes that explain the CHD phenotype. Similar to European populations, we found that CHD in diverse populations is enriched with genes associated with genetic syndromes in which CHD comprises a major part of the phenotype. More interesting is our new gene discovery that will increase our understanding of the genetic basis of CHD. Additionally, we are conducting mouse model experiments on unique vitamin A pathway variants from our cohort that will contribute to our unde rstanding of gene-environmental interactions.
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    Open Access
    Monogenic nephrotic syndrome in Nigerian Children
    (Elsevier Inc, 2020) Esezobor, C.I.; Solarin, A.; Cason, R.; Varner, J.; Chryst-Ladd, M.; Lane, B.; Ekure, E.N.; Gbadegesin, R.
    drome (NS) in African children is unknown despite evidence pointing to racial differences in the prevalence and clinical course of NS. The objective was to determine the frequency of single gene mutations in Nigerian children with idiopathic NS. Methods: Genomic DNA from 89 children with NS from 89 families was screened for mutations in 40 NS genes by targeted sequencing of custom amplicons (TSCA) followed by confirmatory direct sequencing. Both strands of the exons were sequenced and the sequences were analysed with the Sequencher Program. We defined pathogenicity using the American College of Medical Genetics variant classification schema. Nephrotic syndrome and response to corticosteroid were defined using the KDIGO guidelines. Results: The study involved 89 (males: 66.3%) children with NS including 11 (12.5%) children with steroid resistant NS. The median age at diagnosis of NS and enrolment in the study was 5.0 (1.3-14.8) and 8.0 (2.1-16.0) years, respectively. We identified pathogenic mutations in two genes (INF2 and TRPC6) in 2 of 89 (2.2%) children with NS. Interestingly, both children have steroid sensitive (SSNS) course. Conclusions: We found single gene mutations in <5% of Nigerian children with NS and highlight the rarity of commonly described NS genes in Nigerian children. There is need for larger multi-site studies to verify the results of this study.
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    Open Access
    Risk of congenital cardiovascular anomalies in patients with non-syndromic orofacial cleft: A preliminary case-control study.
    (Medical and Dental Consultants' Association of Nigeria., 2020-11) James, O.; Erinoso, O.A.; Adamson, O.O.; Sokunbi, O.J.; Agbogidi, F.O.; Adekunle, A.A.; Ogunlewe, A.O.; Ekure, E.N.; Adeyemo, W.L.; Ladeinde, A.L.; Ogunlewe, M.O.
    Background: Orofacial clefts (OCs) are one of the most common craniofacial anomalies and are reported to be associated with congenital cardiovascular anomalies (CCAs). However, there is paucity of data in African populations on the risk of CCAs in OC patients compared to the general population. Aims: This study aims to determine the odds of congenital cardiovascular anomalies in patients with OC compared to the general population. Subjects and Methods: A case‑control study design was used. Case subjects were non‑syndromic OC subjects, while controls were non‑syndromic subjects without OC. All subjects were thoroughly assessed by a pediatric cardiologist for CCAs; and grouped by OC phenotypic type (cleft lip and/or alveolus, cleft lip and palate, cleft palate only and Tessier cleft). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was placed at P value ≤0.05. Results: A total of 120 subjects (60 cases and 60 controls) were enrolled in the study. In total, 23.3% of the subjects had CCAs. Among the case group, 40% had CCAs compared to 6.7% in the control group. Patent foramen ovale (18.3%) and atrial septal defects (10.0%) were the most common type of CCAs in cases, respectively. Further, cases had significantly higher odds of CCAs compared to controls (OR: 9.3; CI: 2.8, 39.4). Conclusions: Our finding reveals that the odds of CCAs are significantly higher in patients with OC than the general population. Future studies could assess the effect of CCAs on surgical outcome.