Neonatal deaths now account for more than two-thirds of all deaths in the first year of life and for about half of all deaths in children under-five years. Sub-Saharan Africa accounts up to 41% of the total burden of neonatal deaths worldwide. Our study aims to describe causes of neonatal mortality and to evaluate predictors of timing of neonatal death at Tamale Teaching Hospital (TTH), Ghana. This retrospective study was conducted at TTH located in Northern Ghana. All neonates who died in the Neonatal Intensive Care Unit (NICU) from 2013 to 2017 were included and data was obtained from admission and discharge books and mortality records. Bivariate and multivariate logistic regression were used to assess predictors of timing of neonatal death. Out of the 8,377 neonates that were admitted at the NICU during the 5-year study period, 1,126 died, representing a mortality rate of 13.4%. Of those that died, 74.3% died within 6 days. There was an overall downward trend in neonatal mortality over the course of the 5-year study period (18.2% in 2013; 14.3% in 2017). Preterm birth complications (49.6%) and birth asphyxia (21.7%) were the top causes of mortality. Predictors of early death included being born within TTH, birth weight, and having a diagnosis of preterm birth complication or birth asphyxia. Our retrospective study found that almost 3/4 of neonatal deaths were within the first week and these deaths were more likely to be associated with preterm birth complications or birth asphyxia. Most of the deaths occurred in babies born within health facilities, presenting an opportunity to reduce our mortality by improving on quality of care provided during the perinatal period.

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10-year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care.

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Congenital arhinia is a life-threatening, rare craniofacial disorder, which, when not identified and managed early can cause severe respiratory distress at birth due to upper airway obstruction. Since neonates are obligate nasal breathers, simultaneous sucking and breathing requirement in neonates with arhinia leads to respiratory distress. Inspiration and expiration through the oral passage alone may result in thoracic retraction, thereby further exacerbating respiratory distress.We report a rare case of congenital complete arhinia with alobar holoprosencephaly in a 9-month-old. With no family history of congenital malformations, maternal risk factors and uneventful pregnancy, a term female neonate was de-livered vaginally without immediate post-delivery respiratory distress. Examination revealed microcephaly, absent fontanelles, fused cranial sutures and bilateral microphthalmia. Breathing was spontaneous, with no immediate signs of respiratory distress. An additional diagnosis of alobar holoprosencephaly was made after a head computed tomog-raphy (CT) scan was done. Management included the initial stabilisation phase of supplemental oxygen and an oro-gastric tube for feeding. The baby did not require both tracheostomy and gastrostomy tubes, as she was not in severe respiratory distress requiring a tracheostomy tube nor having difficulties feeding with the orogastric tube.

Background Pediatric heart diseases (PHDs), comprising congenital heart diseases (CHDs) and acquired heart diseases (AHDs) are significant contributors to non-communicable diseases in children. CHDs alone occur in 0.8-1.0% live births globally. Data on echocardiogram diagnosed PHDs in Ghana however is lacking. We set out to describe the echocardiogram diagnosed prevalence of the various PHDs, their age profile and change in trends over an eleven-year period in children less than sixteen years seen in Kumasi.  MethodsWe retrieved archived first echocardiogram scan reports from January 2010 through December 2020, and extracted the diagnosis, scan date and sex of the patients. PHDs were categorized into CHDs and AHDs and proportions of the top five reported respectively. Observed trends in proportion of types of PHDs and age at first diagnosis were computed. Data was collected using Microsoft® Excel and analyzed with R statistical software. ResultsPHDs were present in 49.9% (2474/4962) of the scans done with 51.5% (95%CI: 49.5-53.5) being males and 93.3% CHDs. The number of different diagnoses were 3344 as some of the patients had multiple diagnosis. Of these, the top five CHDs were Ventricular Septal Defect (699, 20.9%), Atrial Septal Defect (634, 19.0%), Patent Ductus Arteriosus (576, 17.2%), Tetralogy of Fallot (318, 9.5%) and Atrio-Ventricular Canal Defect (222, 6.6%). That for AHDs were Rheumatic Heart Disease (61, 1.8%), Dilated Cardiomyopathy (46, 1.4%), pericardial effusion (29, 0.9%), Hypertrophic Cardiomyopathy (26, 0.9%) and Infective Endocarditis (14, 0.4%). Proportion of various PHDs stayed constant over the years (p=0.129). The median (IQR) age in months for acyanotic CHDs (6, 1.5-18), cyanotic CHDs (15.0, 4.0-36.0) and AHDs (72.0, 19.0-120) were significantly different (p<0.001). Age at diagnosis reduced by 0.46 months per year, (95%CI: 0.01 to 0.92, p=0.046) over the 11-year period. ConclusionPrevalence of CHDs and AHD are similar to other reports worldwide and has remained largely unchanged over the 11-year period. Age at first diagnosis however is reducing for all PHDs.