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Tuberculosis (TB) is an important infectious disease of public health concern. The effects of TB on children in terms of morbidity and mortality is more than that of adults. These may not be unconnected with the differences in characteristics and peculiarities of the disease in children. Tuberculosis in children is usually primary, paucibacillary, characterized by difficulties in diagnosis of both drug susceptible and resistant TB associated with poor uptake of preventive therapy for those with latent infection, contacts and people living with HIV and AIDS (PLWHA) in most developing countries. While significant similarities exist between spectrum of TB occurring in adults and children, the characteristics and peculiarities of childhood TB may be unknown to policy makers and some clinicians, hence giving it less focus in control measures. The aim of this review is to highlight some of the characteristics and peculiarities of TB in children using PubMed/PubMed Central (PMC) and MEDLINE databases searched for relevant search strings from December, 2018 to September, 2019. Appropriate hard copies of books and journal articles were also included. Conclusion: While the management of TB in children is characterized by difficulties due to both peculiarities of children and the disease; with detailed clinical assessment and examination of necessary specimen in addition to strict adherence to the guidelines of the national TB control program, more cases of TB in children can be prevented, diagnosed, treated and reported.

Background: Malaria has remained a major public health problem in Nigeria with the under-five aged children and pregnant women being the most affected. The local epidemiological profile of the disease is dynamic owing to the continuous variation in the various determinants and hence the need for periodic re-evaluation. We aim to determine the prevalence of malariaparasitaemia among the under -five aged children and the effect of various determinants. Material and Method: In this cross-sectional study, 433 out- patients aged below 5 years with fever or history of fever in the previous 72hours were enrolled. Relevant information was obtained and recorded using a questionnaire. Thick and thin films were prepared from a finger or heel prick for each of the patients and subjected to microscopy. Result: The prevalence of malaria parasitaemia was 27.7%. Age, sex, nutritional status, socio- economic class, temperature at presentation as well as ownership of insecticide treated nets had no significant effect on the prevalence of malaria (p>0.05). Only P. falciparum was seen in all the positive slides. The parasite density was generally low with 48.3% having parasite densities below 100/μl and only 7.5% had parasite density of ≥1000/μl. Parasite density increased significantly with increasing age (p=0041). Nutritional status as well as other studied factors had no significant effect on parasite density (p>0.05). Conclusion and Recommendation: Prevalence of malaria infection was high in the population studied. It is characterized by low density parasitaemia and hence the need to interpret negative results with caution. Age, gender, socio-economic and nutritional status, temperatureat presentation as well as ownership of ITN had no significant effect on prevalence of malaria parasitaemia. There is need to strengthen and scale up various malaria control programs while ensuring proper implementations of programs and activities through effective monitoring and evaluation.

Background: Pneumonia is one of the commonest causes of morbidity and mortality in children, especially in developing countries. These children are also at risk of other morbidities, thus, increasing the morbidity and mortality. Objective: This study was conducted to examine the prevalence and pattern of co-morbidities in children admitted for community acquired pneumonia (CAP) in Maiduguri. Methodology: All children admitted into the Emergency Paediatric Unit (EPU) of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in 2011, with CAP were prospectively followed until discharge or death. The children were evaluated for co-morbidities clinically and by examination of appropriate specimen where necessary. Result: A total of 115 children aged one month to 14 years were admitted for CAP during the study period. While majority of the children studied were underfive; 107 (93%), 65(56.5%) were males, 101 (87.8%) had one or multiple co morbidities, with about half of them 58 (50.4%) afflicted by malaria. Pre admission medication was commoner for orthodox than traditional medication. No significant difference in mortality outcome was however noticed between children with co-morbidity and those without comorbidity, p > 0.05. Conclusion: The occurrence of comorbid conditions among children hospitalized for CAP in Maiduguri is common; however, the presence of co-morbidity did not significantly affect the mortality outcome of their management. It is recommended that the presence of comorbidity be actively looked for in children hospitalized for pneumonia, so as to effect holistic treatment, and improve the outcome of management.

Background: Pneumonia remains a leading cause of U-5 morbidity and mortality in developing countries like Nigeria. This study was conducted to determine the clinical presentation, complications and factors contributing to mortality in the hospitalized children with community acquired pneumonia (CAP) in Maiduguri, Nigeria. Methods: Children younger than 14 years admitted into the Emergency Paediatric Unit of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in 2011 with the diagnosis of community acquired pneumonia were followed up until discharge or death. Chest radiographs were read by radiologists. Results: Eighty nine children aged two months to 14 years were studied. The commonest clinical features were fever, cough, tachypnoea and dyspnoea. Radiographic evidence of pneumonia was found in 84 (94.4%) of cases. Dehydration and congestive cardiac failure (CCF) were the commonest complications encountered. Eight (9.0%) children died, seven of whom had complications of pneumonia. The rate of occurrence of complications, radiographic pattern of pneumonia and outcome of treatment did not significantly differ statistically in the different age groups; p = 0.135, 0.622 and 0.167 respectively. Conclusion: While dehydration and CCF were found to be commonest complications, mortality was commoner among the male infants hospitalized for pneumonia.

The causative agents of acute bacterial meningitis vary from time to time and from place to place. In addition, changes in pathogen’s sensitivity to antibiotics in use occur. The study was undertaken to identify the pattern and susceptibility of pathogens to antibiotics among children beyond neonatal period for prompt empirical treatment of this important cause of morbidity and mortality especially in developing countries. Objective. To identify the pattern and susceptibility of pathogens in acute bacterial meningitis among children aged one month to 12 years at ABUTH Shika, Zaria. Method: This was a prospective study carried out in children presenting to Emergency Pediatric Unit of ABUTH Shika, Zaria, from October 1 st 2005 to September 30th, 2006. Children who met the inclusion criteria for lumbar puncture were consecutively recruited. Cerebrospinal fluid (CSF) samples were collected for microscopy, culture, sensitivity, and Latex Particle Agglutination (LPA) test. Sixty-six (66) patients satisfied the criteria for acute bacterial meningitis and were studied. Results: The prevalence of acute bacterial meningitis in this study was 6.9%. Sixty-six patients with acute bacterial meningitis were identified using 3 diagnostic methods (Gram stain, culture and LPA). The 3 commonest organisms were Streptococcus pneumoniae 34 (51.5%), Haemophilus influenzae 18 (27.3%), and Neisseria meningitidis 12 (11.2%). The sensitivity of the isolates to three commonly used noncephalosporin antibiotics was chloramphenicol 74.4%, penicillin 38.5%, and ampicillin 2.6%. The sensitivity to the cephalosporin was cefotaxime 97.4%, and ceftriaxone 89.7% while that to Ofloxacin, a quinolone, was 100%. Conclusion: The three commonest bacterial agents causing post neonatal meningitis were Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. There is an increasing resistance to the three commonly used nonc e p h a l o s p o r i n a n t i b i o t i c s (chloramphenicol, ampicillin and penicillin) and hence, cefotaxime or ceftriaxone should be used in the empirical treatment of children with suspected acute bacterial meningitis beyond neonatal period

Summary Background: Hepatitis B virus (HBV) is the organism responsible for one of the most prevalent chronic infectious diseases and is widespread throughout the world. Objectives: The sero-prevalence of HBV infection among children presenting to the University of Maiduguri Teaching Hospital (UMTH), Nigeria was investigated with a view to assessing the scope of HBV infection among children in this part of the country and correlating serological findings to epidemiological data. Methods: This was a hospital-based cross-sectional study of 276 children attending the paediatric clinics of UMTH from July 2007 to December 2007. The subjects were recruited consecutively, from the population of patients aged four months to 15 years. A protocol detailing epidemiological data, history of HBV vaccination and physical examination was completed for each of the patients. All the study samples were tested for hepatitis B surface antigen (HBsAg) by the ELISA method, making use of Wellcozyme HBsAg commercial kits (Wellcome Diagnostics, Dartford, England). . Results: The overall prevalence of HBsAg among children tested was 9.4 percent. The highest frequency of HBsAg was observed in children two years and below (38 percent). HBs antigenaemia was higher among males than females, although the difference was not statistically significant (x2 = 0.861. df =1 p = 0.354). No significant difference was observed between HBsAg status and socio-economic class (SEC) of the study population (X? = 6.930. df = 4 p=0.140). There was however, a significant association between lack of immunisation and HBs antigenaemia (Fisher's exact test p < 0.000, RR = 0.463; 0.370-0.580). Conclusion: The prevalence of HBs antigenaemia among children in Maiduguri was high. HBV predominantly infects children in their infancy and early childhood without a significant gender disparity. Lack of HBV vaccination was significantly associated with HBsAg positivity.

Objectives: To determine the prevalence and pattern of hypoglycemia among children admitted to the Emergency Pediatric Unit (EPU) at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria., Methods: A cross-sectional study was conducted between February and September 2020. Blood glucose, along with other relevant laboratory investigations, was measured for each patient upon admission to the EPU using a point-of-care test glucometer (ACCU-CHEK with strips)., Results: Of the 340 children recruited for the study, 54 patients had hypoglycemia (<2.2 mmol/L), giving a prevalence rate of 15.9%. Thirty-six (66.7%) of the children with hypoglycemia were under the age of 5 years (odds ratio [OR]: 6.218 [1.077-35.912], p =0.041) and 26 (48.1%) were severely underweight (OR: 3.692 [1.266-10.971], p =0.017). Factors such as not having eaten for at least 16 h, weakness, and coma at presentation all independently predicted hypoglycemia (OR: 5.696 [1.768-18.352], 6.556 [1.730-24.850], 9.479 [3.092-29.059], p =0.004, 0.006 and <0.001) respectively. Severe malaria was also independently related to hypoglycemia (OR: 2.720 [0.554-13.365], p =0.021)., Conclusion: Hypoglycemia is a common occurrence among children admitted to the EPU. Factors such as being under five years old, in a coma, weakness, severe malaria, and prolonged fasting were all identified as independent predictors of hypoglycemia. Therefore, routine blood glucose monitoring of children admitted to the EPU, specifically those at higher risk, is recommended., (Copyright: © Saudi Medical Journal.)

The kidney is an important target organ in human immunodeficiency virus (HIV) infection, and a variety of renal disorders could occur throughout the course of the disease. HIV- associated nephropathy (HIVAN) is the most common form of kidney disease resulting directly from HIV infection. The true prevalence of HIVAN among infected African children is unknown largely due to lack of surveillance and reporting. We thus aimed to determine the prevalence of HIVAN and associated factors among HIV-infected children at the University of Maiduguri Teaching Hospital. This was a cross-sectional study carried out at the Pediatric Infectious Clinic. Children aged ≤15 years were recruited through systematic random sampling. Relevant sociodemographic and clinical information were obtained. Spot urine sample was analyzed using a multistix (Combi-Screen 10SL Analyticon Biotechnologies AG, Germany), and proteinuria of ≥2+ was considered significant. The CD4+ count and CD4+% (for those <5 years) were obtained using a PARTEC™ CD4+ easy count kit. The obtained data were entered and analyzed using Statistical Package for the Social Sciences version 16.0. A total of 250 children were recruited. Eighty-five (34%) of them had HIVAN. Sex, social class, and mode of transmission were not significantly associated with HIVAN (P >0.05). However, age, medication status (highly active antiretroviral therapy [HAART]), duration on HAART, and disease severity (both clinical and immunological) all had a significant association to HIVAN (p = 0.005, 0.004, 0.008, and <0.001, respectively). These factors also showed a positive but weak correlation to HIVAN; while age had the least correlation coefficient (0.157), immunological class had the highest r = 0.458. However, these relationships were all significant (P <0.5). HIVAN is highly prevalent among children living with HIV in Maiduguri. Routine screening through urina-lysis and early commencement of HAART is recommended., Competing Interests: None

We aimed to determine the prevalence of urinary schistosomiasis among internally displaced children in Maiduguri, Nigeria. Data on the children's sociodemographic characteristics and risk factors for schistosomiasis were collected, over a period of six months, using an interview-based questionnaire. Ten milliliter of urine sample was collected from each child and investigated for hematuria and ova of Schistosoma haematobium. Two hundred and thirty-eight of 385 children had urinary schistosomiasis (62.0%); of this, 125 (53.0%) were males, with a male:female ratio of 1.1:1. Urinary schistosomiasis was the most common among 5-9 years' age group, low social class children, and children of farmers, P <0.05. Stunting was significantly associated with urinary schistosomiasis, P <0.05. It is concluded that urinary schistosomiasis in children was more frequently associated with stunting and low social class. It was a very common disease among internally displaced children in Nigeria., Competing Interests: None

Background. Tetanus toxoid immunisation of pregnant mother has remained the most effective strategy in eliminating neonatal tetanus. Impaired production and/or transplacental transfer of antibodies may affect the effectiveness of this strategy. We studied the effect of maternal HIV infection on serum levels and transplacental transfer of anti-tetanus antibodies. Methods. A total of 162 mother-baby paired serum samples were taken and analysed for anti-tetanus antibody levels using ELISA. Maternal HIV status was also determined by double ELISA technique. Maternal TT vaccination status was also documented. Results. Thirty-eight (23.5%) mothers and 41 (25.3%) babies were seronegative, out of whom 8 mothers were HIV positive and 9 babies were HIV exposed. HIV infected mothers and HIV exposed infants were, respectively, 16.27 times (OR = 16.27, 95% CI = 3.28 to 80.61) and 33.75 times (OR = 33.75, 95% CI = 4.12 to 276.40) more likely to be seronegative for anti-tetanus antibody. Similarly, HIV positive mother-newborn pairs were 7.46 times more likely to have a poor transplacental transfer of tetanus antibodies (OR = 7.46, 95% CI = 1.96 to 28.41). Conclusions. Maternal HIV infection is associated with impaired maternofoetal transfer of anti-tetanus antibodies and seronegativity among mothers and their newborns. Hence, this may hinder efforts to eliminate neonatal tetanus.

Background: Malaria has remained a major cause of morbidity and mortality among the under-five children in Nigeria. Prompt and accurate diagnosis of malaria is necessary in controlling this high burden and preventing unnecessary use of anti-malarial drugs. Malaria rapid diagnostic test (MRDT) offers the hope of achieving this goal. However, the performance of these kits among the most vulnerable age group to malaria is inadequate., Materials and Methods: In this cross-sectional study, 433 out-patients, aged <5 years with fever or history of fever were enrolled. Each candidate was tested for malaria parasitaemia using ACON; malaria pf. Thick and thin films were also prepared from the same finger prick blood for each candidate., Result: Malaria rapid diagnostic test had sensitivity of 8.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 74%. The sensitivity of MRDT increased with increasing age. This effect of age on sensitivity was statistically significant (P = 0.007). Similarly parasite density had significant effect on the sensitivity of MRDT (P = <0.001)., Conclusion: Histidine-rich protein-2 based MRDT is not a reliable mean of diagnosing malaria in the under-five age children with acute uncomplicated malaria.

Background: Infants are protected from measles infection by maternal measles antibodies (MMA). The level of these MMA at birth in newborn children depends on the levels in their mother and the extent of placental transfer. We investigated maternal HIV infection as a predictor of levels of MMA in mother-infant pairs in Maiduguri., Methods: A total of 180 mother-infant pairs were tested for MMA between 15th January and 29th March 2010. Levels of MMA were measured using enzyme linked immunosorbent assay (ELISA) test., Results: Fifteen (8.3%) mothers were found with HIV infection and all were on antiretroviral treatment for HIV, and all of them had protective MMA. Of these mothers with HIV infection, only one (0.6%) of their newborn infants had un-protective level of maternal measles antibody. Maternal measles antibodies in mother-infant pairs had significant correlation (p = 0.005) for both HIV-infected and HIV-uninfected groups. The mean MMA of the newborn children was lower in infants of HIV-infected mothers than in HIV-uninfected mothers (p = 0.37). Linear regression analysis showed no significant association between maternal HIV infection and MMA in mother-infant pairs (p = 0.72) for mothers and (p = 0.37) for newborn infants., Conclusion: Maternal HIV infection was not associated with significantly reduced MMA in mother-infant pairs, as high protective levels were evident in both mother-infant pairs at birth.

Background: Human immunodeficiency virus (HIV) infection is a major cause of infant and childhood mortality and morbidity; without treatment about 50% of them will succumb to HIV/AIDS before the age of two years., Objective: to evaluate the usefulness of clinical manifestations of HIV infection as a surrogate for CD4 counts in antiretroviral-naive HIV-infected children., Methods: newly diagnosed HIV-infected children, antiretroviral-naive attending a paediatric infectious diseases unit were enrolled. The clinical manifesta-tions, age, sex, and WHO clinical stage of each patient were determined. CD4 count and CD4% were estimated at presentation and correlated with various clinical manifestations of HIV disease., Results: the study population consisted of 126 children, aged four months to 14 years with a mean of 3.2 ± 2.7 years and a male to female ratio of 1.2:1. Eighty-one percent of the children acquired HIV infection through mother-to-child transmission (MTCT). The CD4% was higher in infants (p < 0.000) and lower in children over five years of age. Eighty-six percent of them in stage 4 were children less than 24 months of age. CD4% showed a modest correlation with WHO paediatric clinical staging (r=0.62, p=0.002). Patients with lymphadenopathy (stage 1) had a high absolute CD4 count whereas patients with failure to thrive had a relatively low absolute CD4 count., Conclusion: WHO Paediatric clinical staging for HIV infection correlates with CD4% and can be used as a surrogate to CD4. CD4 count and CD4% vary with age and complications of the disease.

Background: HIV and hepatitis B virus (HBV) co-infected patients have a significantly increased risk of dying from liver disease especially after starting treatment with highly active antiretroviral therapy. We aim to determine the prevalence of hepatitis B surface antigenaemia in HIV-infected children and their significance in relation to hepatic functions., Method: Two hundred and eighty four HIV-infected children aged between 4 mouths to 15 years attending the Paediatric infectious disease clinic of University of Maiduguri Teaching Hospital (UMTH) Maiduguri, Nigeria from September 2007 to December 2007 were the subject for this study. Two hundred and seventy six HIV-negative children with served as age and sex-matched controls. They underwent investigations to evaluate the liver function (serum alanine transferase (ALT), alkaline phosphotase (ALP) and bilirubin) and the prevalence of hepatitis B surface antigen (HBsAg) using ELISA technique., Results: Prevalence of HBsAg of 19% and 9.4% was observed among HIV-infected children controls (p = 0.004). Serum ALT and bilirubin concentrations were significantly higher in the HIV-infected group compared to the controls, (p < 0.05). HIV-infected children with HBs antigenaemia had significantly higher ALT and ALP concentrations compared to those without HBs antigenaemia (p < 0.05)., Conclusion: These findings point to the high risk of HBV infection and continual paranchymal damage in HIV-infected children before commencing ART. Vaccination against HBV should eliminate this risk. Ideally HBV serology should be evaluated before starting ART to help guide therapeutic decision-making.

One hundred and forty five children aged 1 month to sixty months who had fever at presentation to the paediatric department of University of Maiduguri Teaching Hospital were investigated for urinary tract infection in this prospective study from November 2004 to October 2005. Prevalence of urinary tract infection was found to be 13.7 per cent. While the female sex and malnutrition were found to be significantly associated with urinary tract infection, height of temperature and symptoms referable to urinary system were not. Ninety per cent of the isolates were Gram negative; mainly coliform Spp, the remaining 10 per cent were due to staphylococcus aureus. Gentamicin was still found to be effective against most of the urinary pathogens. However, clavulinic acid potentiated amoxicillin, ampicillin, nalidixic acid and cotrimoxazole were found to be poorly effective. We therefore conclude that all ill children especially younger ones presenting with fever be screened for urinary tract infection. A regular surveillance of urinary tract infection pathogens and their antibiotic sensitivity pattern is recommended.

The aim of this study was to propose an alternative approach to traditional knowledge, attitude and practice (KAP) studies to enhance the quality of data on which educational health programmes are based. The methodology proposed and illustrated involved a triangulation of approaches derived from linguistics, cognitive science, and medical laboratory sciences. Three diarrhoeal health talks (educational messages) as given to mothers in three primary-care facilities in Borno State (Northeast Nigeria) were subjected to a linguistics analysis. Relationships were then sought between the ontology of knowledge in the health talks as revealed by the text analysis and two other kinds of data, namely: (a) mothers' answers to a set of ecologically-sensitive reasoning questions that test how much relevant inferential knowledge the health talks allow for and (b) results of microbiological and biochemical analyses of salt-sugar rehydration solutions prepared by mothers participating in the study. The findings of the study show a relationship between contents/formatting of the health talks and the extent to which relevant inferential competence was supported or demonstrated by mothers. It was also evident that the laboratory analyses could be related either directly to the health talks or indirectly in terms of what the health talks need to emphasize on. The conclusion shows how the methodology proposed addresses shortcomings of traditional KAP studies in respect of the gap between health knowledge and practice.

One hundred and ninety-four children with severe protein energy malnutrition were investigated for urinary tract infection in this prospective study. The prevalence of urinary tract infection was found to be 11.3 per cent. There was no difference either between the sexes or the different categories of malnutrition. The commonest isolates were Gram-negative organisms predominantly Escherichia coli. The antibiotic sensitivity pattern of the organisms in this study differs from other reports. In this study, we observed poor sensitivities of organisms especially the Gram negatives to the second and third generation cephalosporins. We therefore conclude that regular surveillance of urinary tract infection pathogens and their antibiotic sensitivity patterns should be carried out.

Serum levels of cross-linked N-telopeptides (NTx) of bone collagen, alkaline phosphatase (ALP), and intact parathyroid hormone (PTH) were determined in 64 premenopausal (PRM) and 86 postmenopausal (PSM) women living in northern Nigeria. Serum NTx values were correlated with ALP activity (r = 0.31-0.58, P < 0.01) and PTH (0. 32-0.35, P < 0.01)) in all of the subjects studied, and were also related to age (-0.47, P < 0.001) and body mass index (-0.45, P < 0. 001) in PRM women. Menopause had the effect of increasing the circulating concentrations of NTx and ALP activity by 15% (P = 0. 001) and 11% (P = 0.02), respectively; however, serum levels of PTH were not different between these two groups of women. Compared with Caucasian counterparts matched for age and body mass index, PSM Nigerian women had significantly increased circulating concentrations of NTx (21.7 versus 16.2 nmol BCE/liter, P = 0.01) and demonstrated a trend towards higher ALP activities and PTH levels. These results indicate that (1) discrete reference intervals should be defined for biochemical markers of bone metabolism in African populations, (2) Nigerian women have relatively higher rates of bone turnover, and (3) further investigation of the implications of increased serum NTx should be undertaken using physical methods such as dual X-ray absorptiometry (DXA) and bone ultrasound attenuation.

There is limited information on HIV infection in children in West Africa. This prospective case series study was done to determine the size of the problem and the feasibility of selective screening for infection based on clinical presentation. It involved infants and other children admitted to the Children's Emergency Ward and Paediatric Medical Ward of the University of Maiduguri Teaching Hospital, Nigeria, from the beginning of September 1992 to the end of September 1994. Clinical evaluation followed by serologic tests (ELISA and Western blot techniques) was undertaken. Descriptive study; frequencies were compared using chi 2 test for Fisher's exact test as appropriate. One hundred and ninety nine (10.9%) of 1,822 admissions were screened. One hundred and fifty eight (79.4%) were ELISA negative and 17 (8.6%) ELISA and WB positive; a further 10 (5%) were ELISA positive but WB indeterminate and 14 (7%) were ELISA positive but WB negative in 12 or untested in two. All the infections were HIV-1. Sixteen (39%) patients (nine WB positive, three WB indeterminate and four ELISA positive only) are dead, 14 from HIV-related illnesses, two (4.9]) are alive and 23 (56.1%) lost to follow up; 11 of the HIV-related deaths involved infants. Presence of persistent diarrhoea, prolonged fever, oral thrush, hepatosplenomegaly, diagnosis of tuberculosis and severe malnutrition with gastroentereritis, and multiple (> 3) diagnosis on admission were significantly (p < 0.05) associated with WB confirmed HIV-1 seropositivity and could serve as indicators for selective screening. HIV-1 infection in hospitalised infants and children has become an important problem in Nigeria, presentation in infancy is associated with a high case fatality rate, and the practice of selective screening based on clinical presentation would appear to be feasible.

A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken. Thirty-two infants (29.6%)had positive blood cultures. The buffy coat was stained with methylene blue and with Gram's stain. Using methylene blue staining, 94% shared organisms in the buffy coat. Whereas using Gram's stain only 50% were positive--all of which were also positive with methylene blue. Twenty-four infants with negative blood cultures had radiological signs of pneumonia. Of these, 83% showed organisms in the buffy coat with both methylene blue and Gram staining. We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distress.