In this review article, the genetics of size at birth, prenatal metabolic programming and the endocrine and metabolic consequences of abnormal size at birth are discussed. In addition, the relevance of fetal origin of adult disease in developing countries and the public health implication as well as future perspectives are also discussed. Being born either small- or large-for-gestational age affects such children and adults in several ways. These include increased risk of type 2 diabetes mellitus, metabolic syndrome, oxidative stress, persistent reduction in growth, cardiovascular disease, osteoporosis and premature pubarche as well as adrenarche. Individuals with abnormal size at birth who experienced rapid growth in the first three years of life have the greatest risk for future metabolic abnormalities. The mechanisms involved in prenatal (fetal) metabolic programming in infants with abnormal size at birth are just beginning to be explored. Both the “thrifty genes” and the “thrifty phenotype” could result in adverse health consequences later in life on exposure to plentiful nutrition. The most important epigenetic reactions affecting genetic transcription are acetylation and methylation. However, the major challenge at this point in time is to link such alterations with modifications in gene expression and ultimately, with metabolic abnormalities encountered in adult life. Thus, developmental origins of health and disease (DOHaD) represent a relatively new frontier of research and with time, some of the discrepancies may be resolved.

Although neonates with severe birth asphyxia are known to be at increased risk of early-onset hypocalcaemia, the magnitude of the problem is not well documented. The objective of this study was to determine the prevalence of early-onset hypocalcaemia in severely asphyxiated neonates. In this case-control study, conducted at St Philomena Catholic Hospital (SPCH), Benin City, Nigeria, the total serum calcium concentrations of 31 full-term neonates with 1-minute Apgar score of 3 or less were measured using the O-cresulphthalein complexone method and the results were compared with those of their counterparts with 1-minute Apgar score of 7 and above. The total serum calcium concentration of severely asphyxiated neonates who received sodium bicarbonate therapy during resuscitation was compared with those of their counterparts who did not receive sodium bicarbonate therapy. All the study neonates (both the asphyxiated and the non-asphyxiated) were examined, at least, twice daily in the first 48 hours of life and their clinical findings were documented. Overall prevalence of early-onset neonatal hypocalcaemia (total serum calcium < 1.75 mmol/L) among asphyxiated neonates was 22.6%. Mean total serum calcium at the ages of 12, 24 and 48 hours were significantly lower among asphyxiated compared to non-asphyxiated neonates (p<0.001). The overall mean serum calcium concentrations were 1.68 + 0.06 mmol/L ( range 1.65 – 1.70 mmol/L) and 1.74 + 0.07 mmol /L(range 1.74 – 1.77 mmol/L) in neonates treated with bicarbonate and those without bicarbonate therapy respectively (p<0.01). Asphyxiated neonates with normal total serum calcium concentrations at the age of 12 and 24 hours maintained this normocalcaemia at the age of 48 hours. The commonest clinical finding among asphyxiated neonates with early-onset hypocalcaemia was convulsion (57.1%). Carpopedal spasm was not a prominent clinical manifestation. Hypocalcaemia was common in the first 48 hours of life in asphyxiated neonates, particularly if they received bicarbonate therapy during resuscitation. Asphyxiated neonates whose serum calcium concentration was normal at the age of 12 hours tended to maintain this normal level at the age of 48 hours.

Although recent trends indicate a rising cigarette-smoking prevalence among adolescents in African countries, data on characteristics and attitudes of these African adolescent smokers are scarce despite the peculiar socio-cultural and economic patterns of African countries compared to Western and Asian countries. This study sought to determine the prevalence of cigarette smoking among public senior secondary (SS) school boys in Oredo Local Government Area (LGA) of Edo State and identify the associated risk factors and behaviors. In this school-based cross-sectional study, anonymous self-administered questionnaire was used in obtaining data on cigarette smoking from 1,060 students in the two males-only secondary schools located in the LGA. The prevalence of cigarette smoking was 12.0%, 22.4% and 17.1% among first-year (SS1), second-year (SS2) and third-year (SS3) students respectively, with an overall prevalence of 16.5%. The mean age at which smoking began was 16.9 + 1.2 years (95% confidence interval, CI = 16.7 – 17.1). A significantly higher risk of smoking was associated with having parents, elder siblings or best friends who smoke. Tolerant attitude of parents and best friends towards smoking by their sons/friends encouraged smoking among students. The two major reasons for taking up smoking were peer pressure effect (36.5%) and the need to mix freely with peers in social situations (22.9%). All the smokers were “light smokers” (smoking less than 10 sticks of cigarette per day). 3.4% of the smokers smoked their first cigarette within 30 minutes after waking up in the morning. Among the smokers, 80.6% admitted smoking was harmful and 60% said they would like to quit smoking but lacked the will power and were uncertain how to quit. Considering that the prevalence of smoking among adolescents tend to increase with age, school-based smoking control intervention programs should start in the primary/junior secondary schools and they must also address family influences on adolescent smoking. Empowering adolescents with skills to resist peer pressure is advocated.

In the paediatric age group, particularly in infancy, hypoglycaemia is a common metabolic problem complicating a variety of clinical conditions, and its coexistence may influence the outcome of the primary disease. This study assesses the prevalence of hypoglycaemia among patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria with cholestasis of infancy. Forty patients aged between 15 days and 12 months who presented with cholestasis of infancy were admitted and screened for hypoglycaemia, using Acutrend glucometer. For patients with low blood glucose values, blood samples were further analyzed, using the standard glucose-oxidase method. Of 2,835 patients admitted over a five-year period, 40 (1.4%) had cholestasis of infancy, giving an incidence of 14 cases per 1000 admissions, with a sex ratio of 2.1: 1 in favour of males. Nine (22.5%) of the 40 infants with cholestasis had at least one blood glucose concentration less than 2.6 mmol/L (hypoglycaemia). Of the nine hypoglycaemic infants, three (33.3%) had one blood glucose concentration less than 1.6 mmol/L (severe hypoglycaemia). Seven (77.8%) of the nine hypoglycaemic infants were diagnosed in the first 36 hours of admission. Lethargy and poor feeding were observed in three infants with severe hypoglycaemia. Six (66.7%) of the hypoglycaemic infants were below 3 months of age. Hypoglycaemia was observed among patients with cholestasis of infancy; the prevalence was higher among infants below 3 months of age.

In Nigeria, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. The objectives are to describe the pattern of thyroid disorders among children and adolescents seen in a Nigerian teaching hospital and highlight the management challenges encountered. In this retrospective study, the case notes of all the children and adolescents with thyroid disorders seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the wards of the University of Benin Teaching Hospital (UBTH) from 2005 to 2011 were audited. The total number of cases seen at the paediatric clinics of the Department of Child Health, UBTH was derived from the clinic attendance register of the department. Of the 8,350 cases seen during the period, 9(0.11%) had thyroid disorders, representing one per 930 cases. Of the 9 patients with thyroid disorders, 6(66.7%) had hyperthyroidism, 2(22.2%) had nongoitrous hypothyroidism and one (11.1%) had euthyroid goiter. The overall mean age at presentation for thyroid disorders was 11.2±4.3 years (95% Confidence Interval, CI = 8.4-14.0) and female-to-male ratio was 4:1. For the patients with hyperthyroidism, the mean age of presentation was 12.8±3.1 years (95% CI= 10.3-15.3) and female-to-male ratio was 5:1. The two children (a boy and a girl) with nongoitrous hypothyroidism were aged 3.5 and 6.0 years respectively. The mean duration of symptoms before presentation was thyroid disorders 1.72±1.2 years (95% CI=0.94-2.50), hyperthyroidism 8.5±1.5 months (95% CI=7.3-9.7). The only case of euthyroid goiter (female) presented at the age of 14 years. The two children with nongoitrous hypothyroidism had florid signs of hypothyroidism, such as growth retardation, mental retardation and delayed developmental milestones at presentation. A high clinic default rate was observed. Hyperthyroidism was the most common form of thyroid disorder observed and patients with thyroid disorders tended to present late.

Maternal Age of 35 years or more at first pregnancy and childbirth is considered advanced reproductive age and a high pregnancy risk associated with increased adverse maternal and perinatal outcomes. The industrialized and developing countries are replete with supporting scientific literatures but only a few data on nulliparous women in our setting hence our interest to appraise the correlates of advanced maternal age at first childbirth and obstetric performance in Nigerian women. The objectives were to determine the influence of advanced maternal age at first pregnancy on the obstetric and perinatal outcomes. To compare the obstetric performance of women advanced in maternal age at first delivery with their younger counterparts and to determine the trend of identifiable adverse outcomes with increasing maternal age at first delivery. This was a retrospective comparative study of 1684 nulliparous women that had their childbirth between 2009 and 2013 at a mission Hospital. Those aged 35 years and above were the study subjects while those aged 20 - 34 years the control. Relevant database was raised from the case files. The prevalence of elderly nullipara in this study was 1.6%. They were statistically significant different in primary level of education (OR = 4.1, P = 0.02), prenatal care lack (OR = 2.6, P = 0.02), caesarean section (OR = 2.5, P = 0.0006), incidental myomectomy (OR = 19.1, P < 0.0001), prolonged pregnancy (OR = 0.6, P = 0.04) and episiotomy at vaginal delivery (OR = 0.5, P = 0.01). They were also insignificantly worse in ante partum hemorrhage (APH), induction of labor, perineal tear, HIV infection, postpartum hemorrhage (PPH), preterm birth, Low birth weight (LBW), Intrauterine growth restriction (IUGR), stillbirth ,neonatal birth asphyxia and Perinatal mortality. Caesarean section rate, caesarean myomectomy, APH, induction of labor, stillbirth rate, LBW and Perinatal mortality each maintained a statistical significant linear tendency (P < 0.05) with maternal age. First pregnancy at advanced maternal age is fraught with increased maternal morbidity, perinatal morbidity and mortality. We proffer early education, marriage or and childbearing, quality prenatal care and skilled attendance at delivery for safe motherhood.

Pre-eclampsia is known to be associated with various placental morphologic changes as well as fetal growth restriction. Growth restricted neonates are at increased risk of hypoglycaemia in the first three days of life. The aim of the study was to examine the relationship between occurrence of neonatal hypoglycaemia and the relative placental weight in mothers with pre-eclampsia. The blood glucose concentrations of 69 neonates born to mothers with pre-eclampsia were determined three times daily during the first three days of life. The birthweight of each of the neonates as well as the corresponding weight of the placenta were determined and recorded. The relative placental weight was calculated using the formula: Weight of placenta x 100/Birthweight of the infant. Overall prevalence of neonatal hypoglycaemia was 47.8%. Of the 69 neonates, severe neonatal hypoglycaemia (blood glucose < 1.6 mmol/L) was prevalent in 10 (14.5%) and 15(21.7%) had blood glucose level between 1.6 and 2.5 mmol/L. The relative placental weight did not differ with the severity of maternal pre-eclampsia. No statistically significant correlation was obtained between the relative placental weight and neonatal hypoglycaemia.

Season is known to influence human secondary sex ratio but information on this subject is lacking in Nigeria. The objective of this study was to determine the secondary sex ratio (SSR) during the wet and dry seasons in Nigeria. In this retrospective cohort study, the records of all deliveries at St Philomena Catholic Hospital (SPCH), Benin City, Edo State, Nigeria between 1st January, 2005 and 31st December, 2014 (10 years) were retrieved and analyzed. The births were recorded according to the year and month of delivery. Stillbirths and infants with ambiguous genitalia were excluded from the analyses. The total number of live-births during the 10-year period under review was 13,702 and this consisted of 7,007 males and 6,695 females, resulting in a secondary sex ratio of 104.6:100 (1.05:1). In general, the monthly distribution of births was bimodal with a greater peak in May and a lesser peak in October with the highest and lowest SSRs in the months of June and March, respectively. In the dry season, the proportion of male births was higher than the proportion of female births; p > 0.05. In contrast, in the wet season the proportion of male births was lower than the proportion of female births; p > 0.05. In addition, the SSR was higher in the dry season (1.04) compared with the wet season (0.99). In Edo State, Nigeria, the proportion of male births tended to be higher than the proportion of female births during the dry seasons.

Although an undescended testes (UDT) is the most common developmental anomaly of the urogenital organ in males, they have often been regarded as mild malformation and as a consequence have been poorly reported despite its association with increased risk of infertility and testicular cancer in later life. In Nigeria, data on its prevalence is scarce. The objective of the study was to determine the prevalence rates of undescended testes at birth, 3 months and 6 months of age respectively. A prospective hospital-based cohort study was conducted to determine the prevalence rates of UDT at birth, 3 months and 6 months of age. The infants were examined at birth for UDT, using standardized technique. The infants who were identified at birth to have undescended testes were re-examined at the ages of 3 and 6 months respectively. To minimize inter-observer error, one physician examined all the infants. The gestational age, birth weight and birth position of each the neonates were recorded. The maternal age, parity, educational attainment and occupation of the parents were noted. The season in which each of the infants was born was recorded. At birth, 2.8% (39 of 1,394) of live-born male infants had undescended testes (UDT). This prevalence rate declined to 1.2% at the age of 3 months and 0.6% at the age of 6 months with an overall spontaneous testicular descent rate of 79.5% (31 of 39 cases). The prevalence rates were significantly elevated for low birth weight and preterm infants. The frequency of spontaneous descent of the testes was higher in both low birth weight and preterm infants compared to normal birth weight and full-term infants respectively. Comparing twin and non-twin infants, the prevalence of UDT was 3.8% (2 of 52) versus 2.8% (37 of 1,342); p>0.05. At birth, low birth weight and preterm infants had a significantly higher prevalence than their full-term as well as preterm counterparts with preterm infants having a greater tendency to achieve spontaneous descent of the testicles than full-term infants.

The offspring of a mother with Graves’ disease is at increased risk of morbidity (both immediate as well as long term) and mortality. The aim of the study was to retrospectively assess the concentrations of the serum Thyroid Stimulating Hormone (TSH), Thyroxine (T4) and Triiodothyronine (T3) as well as the anthropometric measurements in the first 6 months of life among offspring of mothers with Graves’ disease. In this study, the case files of all infants born to mothers with Graves’ disease who were referred to the Paediatric Endocrinology Clinic, University of Benin Teaching Hospital (UBTH), Benin City were retrieved and audited. The thyroid function tests (TFT) results as well the anthropometric data obtained in the first 6 months of life for offspring of mothers with Graves’ disease were recorded. Of the 10 neonates born to mothers with Graves’ disease, the thyroid function was normal in eight (80.0%) and abnormal in two (20.0%). Of the two infants with abnormal thyroid function, one had Transient Hyperthyrotropinaemia (elevated TSH with normal fT4) and the other had Euthyroid Hyperthyroxinaemia (elevated fT4 with normal TSH and no clinical symptoms). No case of neonatal Graves’ disease was observed. In the first 6 months of life, there was no statistically significant difference in anthropometric measurements between offspring of mothers with Graves’ disease and their counterparts whose mothers did not have Graves’ disease. Conclusion: Majority of infants born to mothers with Graves’ disease had normal thyroid function but the two leading abnormality of thyroid function observed in the newborn were Transient Hyperthyrotropinaemia and Euthyroid Hyperthyroxinaemia. No statistically significant difference was observed in the anthropometric measurements of offspring of mothers with Graves’ disease and those of mothers without Graves’ disease