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Monday, September 30, 2013

" The Baby Refused to Die"

The story
The pregnancy was unremarkable. The beautiful baby girl was born well, without any health concerns. At about two months of age, she developed an infection which was treated with antibiotics. As usual in Nigeria, she was also treated for malaria. Anyway, soon after, the mother noted that the head of the baby started getting bigger. Just like that! What could be going on?
The baby had suffered a brain infection called meningitis. This blocked off the normal paths through which water flows out of the brain. You see, the brain manufactures brain water to keep the nerves moisturised.
The brain has water to keep it moist and allows the flow of nutrients to the nerves. The brain regulates the amount of the water (called cerebrospinal fluid) by making and removing the water almost at the same rate. The water is made and removed daily like clockwork. The water is, however, removed through tiny channels or holes which can become blocked by blood or debris from infection.
So, if there is any obstruction, the brain is too stupid to know and just continues to manufacture water. This causes the water to build up, and now, start damaging the brain because of the pressure. In babies, the bone of the skull is soft (not yet joined together) and so the early sign of hydrocephalus is enlargement of the head of the baby.
In adults, the skull cannot enlarge, so the patient complains of severe headache. Hydrocephalus can cause confusion, headaches, deafness, blindness, paralysis, coma and severe brain damage, as well as death. It has to be treated — and very early, too — before damage occurs.
Treating hydrocephalus requires a brain surgeon to use a tube called a VP SHUNT to bypass the site of the blockage in the brain. Plumbers and engineers will understand this. The shunt removes the brain water and releases the pressure. It therefore protects the brain from further injury.
Attempted murder
This is how the journey to attempted murder started…
The head of the baby was growing faster than her body. The thin neck therefore could no longer support the big head. The baby became irritable, crying all the time, vomiting, stopped eating and drinking, and was obviously ‘tired.’ The baby was weak and the eyes seemed to be permanently looking at her toes. This was so bad you could only see the white of her eyes and it was as if the eyes were ‘the sun setting.’
The family decided to leave the baby alone and let her die. This was also because of the financial implication of an operation and medical treatment. The family felt they could not cope with a disabled baby who has become the butt of jokes and a baby other children and adults stare at. The mother stopped taking her out and refused visitors to the house.
The baby refused to die
However, the baby refused to die and so the family gave her another chance to live. Fortunately, they found a well wisher who was able to help pay for the shunt operation. The baby was taken to Abuja and had the operation performed successfully. The head became smaller once the pressure was off and the baby improved.
Hydrocephalus awareness
Children living with hydrocephalus in Nigeria are stigmatised because of their big heads and the fact that they are not able to function as well as their mates. Sadly, many ill-advised and illiterate parents are not aware of the condition. They are also not aware that it can be easily treated and they call these children demons or evil spirits.
We have heard of parents who throw these children into the bush, abandoned, starved to death and even given ‘mercy killing.’ Creating awareness about this problem is therefore of utmost importance.
Hydrocephalus is a preventable illness. It is also easily treated. But, the treatment must be done before brain damage occurs. We have only one brain and about two to three billion nerves. Nerves do not reproduce; so, if they are damaged, it might be permanent. This is why any injury to the brain and spinal cord must be treated expeditiously.
Doctors, midwives and nurses also need to be educated about this. It is important for us not to ignore the parents when they complain about their children and anything affecting their health. I have always believed that the ‘mother knows best.’ All efforts must be made to evaluate the complaint of the mother and lay it to rest with sound scientific arguments or effective treatment.
Antenatal care and education of pregnant women about hydrocephalus is important. A routine good quality ultrasound scan to detect problems in the baby is important. Health talk during antenatal should include prevention of childhood infection and regular immunisation as scheduled after delivery. Babies must take all their injections to prevent infections.
One important message for women is to take folic acid before getting pregnant. Nigerian women planning to have a child should start taking the medication before pregnancy and throughout pregnancy to help the baby’s brain develop normally. This can help prevent hydrocephalus and other brain problems. The government might also wish to encourage the inclusion of folic acid in bread, wheat and other foodstuff to help prevent such diseases. Other foods rich in folic acid are spinach, avocados, oranges, pasta, rice and flour.
Dr Biodun Ogungbo

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