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Preview: Journal of Tropical Pediatrics - current issue

Journal of Tropical Pediatrics Current Issue





Published: Wed, 31 Jan 2018 00:00:00 GMT

Last Build Date: Thu, 01 Feb 2018 09:46:16 GMT

 



In this Issue 64/1

Wed, 31 Jan 2018 00:00:00 GMT




Rotavirus Vaccines: A Social Injustice Story

Mon, 09 Oct 2017 00:00:00 GMT

Diarrheal diseases remain the second leading cause of infectious mortality among children worldwide [1], with rotavirus accounting for the largest burden [2], some 200 000 deaths annually [3]. Tremendous progress has been made in decreasing morbidity and mortality because of diarrhea, with the number of deaths declining by ∼20% from 2005 to 2015. Deaths attributable to rotavirus among children <5 years of age declined a staggering 44% during this period [3]; rarely in human history has the mortality rate from a single infection decreased so rapidly, although the uneven nature of progress continues to highlight the great income disparities that plague our modern world [4]. In fact, the rotavirus story in recent years is one beset by tragedy, a parable of social injustice writ large with the lives of millions of unnecessary child deaths.



Factors Influencing the Academic Performance of Children with Sickle Cell Anaemia in Ekiti, South West Nigeria

Fri, 26 May 2017 00:00:00 GMT

ABSTRACT
Background
There is a paucity of information on factors that influence the school performance of children with sickle cell anaemia (SCA) in Nigeria, despite her huge burden of the disease.
Methods
In total, 101 children with SCA were recruited at a paediatric clinic in Nigeria. Their socio-demographic-matched classmates were the controls. Academic performance and cognitive functioning were obtained from school reports and Ziler’s Draw-a-Person Test, respectively. Factors influencing the academic performance were determined.
Results
Children with SCA had higher rates of school absence and lower haemoglobin concentration (p < 0.05). There was no difference in overall school performance between children with SCA and controls (59.0 vs. 60.6%; p = 0.256). School absenteeism > 1 week independently predicts poor school performance among the study participants (odds ratio = 15.71; 95% confidence interval = 5.93–41.66; p =0.000). Most SCA children with poor performance were absent from school for > 1 week.
Conclusion
There is need to address causes of school absenteeism among children with SCA.



Post-neonatal Tetanus in a PICU of a Developing Economy: Intensive Care Needs, Outcome and Predictors of Mortality

Thu, 27 Apr 2017 00:00:00 GMT

ABSTRACT
Objectives
To evaluate pediatric intensive care unit (PICU) needs, outcome and predictors of mortality in post-neonatal tetanus.
Materials and methods
Review of 30 consecutive post-neonatal tetanus cases aged 1 months to 12 years admitted to a PICU in north India over a period of 10 years (January 2006 to December 2015).
Results
Chronic suppurative otitis media was the commonest portal of entry. All received tetanus toxoid, human tetanus immunoglobulin (HTIG) and appropriate antibiotics; 7 (23.3%) received intrathecal HTIG. Common complications were respiratory failure, rhabdomyolysis, autonomic dysfunction, acute kidney injury and healthcare-associated infections. PICU needs were as follows: ventilation; benzodiazepine, morphine and magnesium sulfate infusion; neuromuscular blockers, inotropes, tracheostomy and renal replacement therapy. Mortality rate was 40%; severity Grade IIIb, autonomic dysfunction, use of vasoactive drugs and those who did not receive intrathecal HTIG were significantly associated with mortality.
Conclusion
Post-neonatal tetanus is associated with high mortality, and PICU needs include management of spasms, autonomic dysfunction and complications and cardiorespiratory support.



Role of Early Onset Neutropenia in Development of Candidemia in Premature Infants

Mon, 24 Apr 2017 00:00:00 GMT

ABSTRACT
Background
The aim of the study was to assess the effect of early-onset neutropenia (EON) on the development of candidemia in premature infants and evaluate other risk factors.
Materials and Methods
This prospective study was carried out in a neonatal intensive care unit of Cairo University Hospital. Fifty neutropenic premature infants were matched to 50 non-neutropenics. Subjects were then regrouped into candidemics and non-candidemics to study other risk factors such as central venous catheters, mechanical ventilation, parenteral nutrition, drugs as corticosteroids and others. Candidemia was assessed by Bactec and then seminested polymerase chain reaction for culture negatives.
Results
Candidemia developed in 28 neutropenic preterms and in 8 non-neutropenics (odds ratio  = 6.68, 95% confidence interval = 2.61–17.1, p <0.001). Risk factors for invasive fungal infection in univariate analysis included bacterial septicemia, mechanical ventilation, parenteral nutrition and steroid therapy. Independent predictors of candidemia in multivariate regression analysis included EON, mechanical ventilation and steroid therapy.
Conclusion
EON is an independent risk factor for candidemia in premature infants.



Pasteurella aerogenes as an Asymptomatic Bacteriuria Agent

Fri, 21 Apr 2017 00:00:00 GMT

ABSTRACT
‘Asymptomatic bacteriuria’ (ASB) is isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen obtained from a person without symptoms or signs referable to urinary infection. Catheterized specimens are less likely to be contaminated compared with voided specimens; therefore, positive cultures of catheterized specimens are more likely to reflect true bladder bacteriuria even with low colony counts. The common pathogens for ASB are Escherichia coli, Klebsiella and Streptococcus spp. Pasteurella spp. was not previously reported as an ASB agent. ASB is important for pregnant women, children, individuals with obstructive uropathy, chronic renal failure and neutropenia, before the urologic procedures and after renal transplantation. Treatment of ASB is required for above situations. We report an 11-year-old-girl with neurogenic bladder who made clean intermittent catheterization and had Pasteurella aerogenes as an ASB agent.



Features of Dengue and Chikungunya Infections of Colombian Children under 24 Months of Age Admitted to the Emergency Department

Fri, 21 Apr 2017 00:00:00 GMT

ABSTRACT
We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue for 19 months (1 January 2013 to 17 August 2014). Prospective data for chikungunya confirmed by real-time polymerase chain reaction were collected for 4 months (22 September 2014–14 December 2014). Sensitivity and specificity [with 95% confidence interval (CI)] were reported for each disease diagnosis. A platelet count <150 000 cells/ml at emergency admission best characterized dengue, with a sensitivity of 67% (95% CI, 53–79) and specificity of 95% (95% CI, 82–99). The algorithm developed with classification and regression tree analysis showed a sensitivity of 93% (95% CI, 68–100) and specificity of 38% (95% CI, 9–76) to diagnose dengue. Our study provides potential differential characteristics between chikungunya and dengue in young children, especially low platelet counts.



Burden of Severe Acute Malnutrition in under-five Children (2–59 Months) Admitted in a Tertiary Care Hospital of Delhi

Fri, 21 Apr 2017 00:00:00 GMT

ABSTRACT
Objective
The aim of the present study is to assess the burden of severe acute malnutrition (SAM) and other malnutrition in a tertiary care hospital in Delhi.
Methods
All patients aged 2–59 months admitted from August 2012 to July 2014 were screened for malnutrition by anthropometry using standard techniques, and SAM was diagnosed as per guidelines [1, 2].
Results
During the study period, 4520 children of age 2–59 months were admitted and complete data of 4354 children were available, which were analysed. Of these, 50.4% were underweight, 44.6% were stunted, 33.5% were wasted, 0.76% had oedematous malnutrition and 18.3% had SAM. Of all patients with SAM, 80% were <24 months old, with 54.1% males and 45.9% females. Moderate acute malnutrition was present in 21.4%. Associated co-morbidities were diarrhoea or respiratory infection or both.
Conclusion
Hospitals of Delhi have a high load of complicated SAM and need adequate infrastructure and facilities for management of these children.



Psychiatric Morbidity in Children with HIV/AIDS at a Tertiary Health Institution in North-central Nigeria

Thu, 20 Apr 2017 00:00:00 GMT

ABSTRACT
Introduction
Children with human immunodeficiency virus (HIV) infection are living longer with the infection and are at risk of different complications. We assessed for the prevalence of and associated factors for psychiatric morbidity among HIV-infected children in a tertiary facility in Ilorin, Nigeria.
Methods
A descriptive cross-sectional, two-staged study involving 196 HIV-positive children (6–17 years). A semi-structured questionnaire and psychological instruments were used for the study.
Results
Thirty-eight (19.4%) children had psychiatric disorders: attention-deficit hyperactivity disorder and enuresis. Single parenthood, HIV clinical stages and complications were associated with psychiatric morbidity. Linear combination of the risk factors was not related to the psychiatric disorder. Bivariate correlation analysis showed the tendency to develop psychiatric disorder among the children was positively correlated with complications in the child and the person the child resides with.
Conclusions
Complicated HIV infection and adverse life events result in elevated risk of having psychiatric morbidity.



Early Total Enteral Feeding in Stable Very Low Birth Weight Infants: A Before and After Study

Tue, 18 Apr 2017 00:00:00 GMT

ABSTRACT
Background
Fear of necrotizing enterocolitis (NEC) has perpetuated delayed initiation and slow advancement of enteral feeding in very low birth weight (VLBW) infants with inherent risks of parenteral alimentation. The objective of this study was to assess effect of early total enteral feeding (ETEF) on day of achievement of full enteral feeds, feed intolerance, NEC and sepsis.
Methods
In total, 208 stable VLBW neonates (28–34 weeks) admitted during 6 month periods of three consecutive years were enrolled. First phase (n = 73) constituted the ‘before’ phase with standard practice of initial intravenous fluid therapy and slow enteral feeding. The second prospective phase (n = 51) consisted of implementation of ETEF with infants receiving full enteral feeds as per day’s fluid requirement since Day 1 of life. The third phase (n = 84) was chosen to assess the sustainability of change in practice.
Results
Day of achievement of full feeds was significantly earlier in Phases 2 and 3 compared with Phase 1 (8.97 and 5.47 vs. 14.44 days, respectively, p = 0.0001). Incidence of feed intolerance was comparable between Phases 1 and 2 (22 vs. 14%, p = 0.28), with marked reduction in incidence of NEC (14 vs. 4%, p = 0.028). There was a significant decrease in sepsis, duration of parenteral fluid and antibiotic therapy as well as hospital stay with comparable mortality.
Conclusion
In stable preterm VLBW infants, ETEF is safe and has the benefit of optimizing nutrition with decrease in sepsis, NEC and hospital stay.



Obesity as a Presentation of Munchausen Syndrome by Proxy

Mon, 17 Apr 2017 00:00:00 GMT

ABSTRACT
Objective
To describe a case of an obese child whose weight gain was related to the Munchausen Syndrome by proxy (MSP).
Methods
This is a case report including information regarding the child’s clinical history and the mother’s behavior. The common features of the syndrome are confronted with the description of the case, seeking to demonstrate the similarities.
Results
The description ratifies the diagnosis based on the signs and symptoms presented by the child (<5 years old, frequent contacts with health system, symptoms witnessed only by the mother, confusing findings, not helped by treatments, emotionally distant father) and the attitude of the mother (concerned, interested in procedures, comfortable in the medical setting, higher medical knowledge, hostile when thwarted).
Conclusion
The case presented points to a new etiology, the MSP, to be considered within the set of factors currently known to cause and maintain obesity in childhood.



Trends in the Prevalence of Morbid Obesity among Children and Adolescents in Shandong, China, 1995–2014

Mon, 17 Apr 2017 00:00:00 GMT

ABSTRACT
Background
Childhood obesity has increased dramatically during the past decades; however, data on the prevalence of morbid obesity is limited. The present study examined the prevalent trends in morbid obesity among children and adolescents during the past 19 years (1995–2014) in Shandong, China.
Methods
Data for this study were obtained from five cross-sectional surveys (1995, 2000, 2005, 2010 and 2014) of schoolchildren in Shandong Province, China. A total of 41 500 students aged 7–18 years were included in this study. Body mass index cutoffs recommended by the International Obesity Task Force were used to define morbid obesity.
Results
The prevalence of morbid obesity was increasing continuously during the past 19 years (1995–2014), from 0.25% for boys and 0.11% for girls in 1995 to 2.73% for boys and 1.29% for girls in 2014. Boys had higher prevalence of morbid obesity than girls (p<0.01). Regional socioeconomic status (SES) inequalities in morbid obesity were observed; children and adolescents from high SES district had a rapid increase in the prevalence of morbid obesity than their counterparts from moderate SES and low SES districts in the past 19 years.
Conclusion
Although the current prevalence of morbid obesity was at a relatively low level, a continuous increasing trend was observed between 1995 and 2014. We should not relax our vigilance, and policymakers and experts should pay more attention to the monitoring and prevention of morbid obesity among children and adolescents in the future decades.



Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities: An Open-Label Randomized Trial

Fri, 24 Mar 2017 00:00:00 GMT

ABSTRACT
Background of the study
Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of sepsis.
Objectives
To study early versus late feeding in preterm IUGR neonates for time required to attain sufficient feed volume to discontinue PN and increased risk of NEC or feed intolerance (FI).
Design
Open-label randomized controlled trial.
Setting
Tertiary care neonatal unit and fetal-maternal medicine unit in India.
Participants
Preterm intrauterine growth restricted neonates’ ≤32 weeks with AREDF on UA Doppler enrolled from 1 January 2014 to 31 July 2015.
Intervention
Randomized to receive early or late feeding using mothers own or donor breast milk as per a feed initiation and advancement protocol.
Primary outcome
Time in days required to attain sufficient feed volume allowing discontinuation of PN and incidence of NEC in neonates fed early versus late.
Results
There were 77 eligible neonates. Sixty-two neonates were included and stratified as extreme preterm (27–29 weeks) (n = 20) and very preterm (30–32 weeks) (n = 42). Ten extreme preterm and 21 very preterm neonates were randomized to each early feeding and late feeding arm. There was a significantly faster attainment of sufficient feeds in the early feeding arm of both the stratified groups [extreme preterm: median 14 days (Interquartile range IQR: 12–15) compared with 18 days (IQR: 18–20), hazard ratio (HR): 1.59, 95% CI: 0.626–4.078; very preterm: 12 days (IQR: 10–14) as compared with 16 days (IQR 15–17), HR: 1.89, 95% CI: 1.011–3.555]. There was no difference in the incidence of NEC, FI and combined outcome of NEC and FI.
Conclusion
Early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler allowed earlier discontinuation of PN, allowing birth weight to be regained earlier and did not increase the incidence of NEC and FI.



Postoperative Stridor following Repair of Tracheoesophageal Fistula: A Case Report

Wed, 08 Mar 2017 00:00:00 GMT

ABSTRACT
We report a case of prolonged post-operative stridor in a full-term neonate who was operated for tracheoesophageal fistula. Initial evaluation including an endoscopy and contrast-enhanced computed tomography scan was normal. Repeat endoscopic evaluation under anesthesia revealed tight aryepiglottic folds. Aryepiglottic split was performed and stridor improved dramatically. Tight aryepiglottic folds should be kept in differential diagnosis in a case of postoperative stridor in an infant.