OJPedOpen Journal of Pediatrics2160-8741Scientific Research Publishing10.4236/ojped.2023.136084OJPed-128194ArticlesMedicine&Healthcare Acute Thoracic Syndrome in Children: Epidemiological, Diagnostic and Evolutionary Aspects at the Albert Royer National Children’s Hospital in Dakar Senegal GuillayeDiagne1*PapaSouleye Sow1KhadimBop1MaimounaSow1IdrissaDemba Ba1Albert Royer National Children’s Hospital, Dakar, Senegal0810202313067637739, August 20237, October 2023 10, October 2023© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric stu dies in this area. The objective of our study was to determine the epidemio logical, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old; the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%); bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultra sound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.

Acute Chest Syndrome Sickle Cell Disease Children Senegal1. Introduction

Sickle cell disease is a hereditary disease with autosomal transmission, clinically recessive and biologically codominant, characterized by the presence in the red blood cells of an abnormal hemoglobin called hemoglobin S. The latter is responsible for the sickling of the red blood cells in a situation of hypoxia [1] . It is one of the most common genetic diseases in France [2] . Acute chest syndrome (ACS) is one of the major complications of sickle cell disease. It is defined by the occurrence in a sickle cell patient of an acute respiratory attack, febrile or not, painful or not, associated with new pulmonary infiltrates on the chest X-ray [3] . Hypoxemia is not present in the definition, but is a predictor of unfavorable outcome [4] . This pathology is more common in the pediatric population with a frequency that decreases with age, the peak incidence being between the ages of 2 and 4 years [5] . In Senegal, the absence of previous studies on the acute chest syndrome and the fact that it constitutes a frequent reason for hospitalization in a pediatric environment motivated the realization of this work in the pediatric pulmonology and continuing care department of the Albert Royer children’s hospital in Dakar with the general objective: To describe the epidemiological, diagnostic and evolutionary aspects of ACS at the Albert Royer children’s hospital in Senegal. The specific objectives were to determine the incidence of ACS at the CHNEAR in Dakar, to determine the major signs of STA and to specify the methods of management of ACS.

2. Methodology

The study was conducted at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar, Senegal. This was a retrospective study from January 1, 2021 to March 31, 2022, i.e. a duration of 15 months. It was descriptive and analytical in patients who were hospitalized for an acute chest syndrome. We included hospitalized patients in whom the diagnosis of acute chest syndrome (ACS) was made whether they were known to have sickle cell disease or not on admission, whose file was available and usable. Any incomplete file was excluded from the study. Sociodemographic, clinical, paraclinical and evolutionary data were collected using a pre-established survey form filled out from patient files. The data collected was entered into the Epi info V 7.2 software. The analysis was performed with Excel 2010 and SPSS version 22 software.

During the analysis, the qualitative variables were described by frequency tables and bar charts. Quantitative variables were described by their positional parameters.

Hypoxemia was defined by a pulsed oxygen saturation of less than 95% in ambient air.

3. Results3.1. Epidemiological Aspects

A total of 3451 children were hospitalized during the study, among them 102 patients were hospitalized for ACS, i.e. a hospital incidence of 2.96%. The average age of the patients was 110 ± 54.6 months and extremes of 12 and 204 months.

3.2. Clinical Aspects

93 patients were known to have sickle cell disease and were followed regularly. The baseline hemoglobin level was 7.59 ± 0.87 g/l.

Sickle cell disease was diagnosed during hospitalization in 2 patients, i.e. 1.96%.

A notion of corticosteroid therapy was found in 11.76% of patients (n = 12). Eighty-eight children (86.27%) had a history of familial sickle cell disease.

Chest pain was present in 79 patients and dyspnea in 79 patients.

Hypoxemia was found in 99 patients, a rate of 97.06% (Table 1).

Pulmonary condensation was found in 72 patients or 70.59% during the pleuropulmonary examination, bronchial syndrome in 17 patients (16.67%) and pleural effusion in 1 patient or 0.98%.

Abdominal pain was the main sign found during abdominal examination in 49 patients (48.04%) and splenomegaly in 14 patients or 13.73%.

The CVO was found in 53.94% (n = 54) of the patients during the osteo-articular examination.

3.3. Paraclinical Aspects

The average hemoglobin level was 6.97 ± 1.44 g/l with extremes of 2.2 and 10 g/l.

The mean leukocyte count was 27469 ± 21885 elements/mm3. The mode and the median were respectively 24000 elements/mm3 and 23950 elements/mm3.

Ninety-two patients (90.20%) had a positive C-reactive protein (CRP) with an average rate of 113 ± 92.73 mg/l and extremes of 5.2 and 350.2 mg/l. Blood culture was performed in 12 patients (11.76%) of which 3 came back positive for staphylococcus aureus.

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