Background: Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. It was hypothesized that applying the principle of underwater seal pressure generation could convert a simple oxygen delivery system into an effective Bubble CPAP device. Objectives: To provide evidence in support of the immediate clinical effectiveness of the NH-BCPAP device. Design/Methods: At the neonatal unit of the National Hospital Abuja, we assembled a circuit of tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-waterseal bottle to generate CPAP. The device is activated by turning on the oxygen source. The device was applied to preterm babies with RDS as well as some term babies with respiratory distress admitted into the neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were monitored before and at 1 hour, 6 hours and 12 hours after the application. Results: Forty eight newborn babies with respiratory distress were treated with the device out of whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6 (10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p<0.05. The corresponding values for SPO2 were 84.5(14) before and 95.9 (5.3), 95.9(6.5) and 96.9(6.4) at 1, 6 and 12 hours respectively, p<0.05. The respiratory changes were however less marked among very low birth weight babies. Conclusion: The simplified customized device produces clinical responses similar to those reported for the conventional CPAP devices.

Background: Although the official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports some anecdotal, of survival of babies  delivered at younger gestational age (GA) from different parts of the country. The routine resuscitation and management of premature infants born before the official age of fetal viability (28 weeks) is likely to generate important ethical and medical concerns that are bound to influence our  approach to the management of such infants. Aim: To determine the GAspecific neonatal mortality and survival among preterm deliveries at the National Hospital Abuja. Subjects and Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database based on the Research Electronic Data Capture software (REDCap) was undertaken to determine the mortality rate of preterm babies managed in the neonatal intensive care unit (NICU) from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. Gestational age estimation was based on mothers’ last menstrual period (LMP) in over  96% of cases.Results: Sixty-three (63) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.7%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal corticosteroid use was low (11.2%), 188  (25.8%) received CPAP for Respiratory Distress Syndrome (RDS), and none of the babies received surfactant or mechanical ventilation. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However, the survival rate at 26 weeks gestation was 53.8%, and this  subsequently increased, reaching a peak of 96.5% survival at 35 weeks. RDS accounted for 53.9% of all deaths. Conclusion: It is concluded that the survival rate (53.8%) of babies at GA of 26 weeks despite minimal antenatal interventions and limited postnatal  respiratory support was reasonably high, and this could serve the basis for discussions for a downward review of the age of fetal viability in Nigeria. Key words: Gestational age. Fetal viability

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We report prune belly syndrome, a rare congenital malformation, in a set of twins delivered to a young couple with a history of three previous first trimester spontaneous abortions, discordant HIV seropositivity and antenatal ultrasound report that indicated renal abnormalities in only one of the twins. The challenges of management are discussed.

Symptomatic subdural haematoma (SDH) in term infants typically occur following traumatic vaginal delivery. Emergency Caesarean Section (EmC/S) carried out after failed attempts at vaginal delivery may also be complicated by symptomatic SDH but spontaneous symptomatic SDH complicating Elective Caesarean Section (ElC/S) is a rarity. We describe a case of massive SDH in a term baby delivered by Elective C/S in the absence of risk factors for intracranial haemorrhage. The aim of this presentation is to highlight the significance of acute subdural haematoma in the diagnostic work up of neonates presenting with acute neurologic symptoms in the absence of traumatic delivery.Key words: Symptomatic subdural haematoma, Caesarean section, severe birth injuries, neonatal seizure