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Preview: Journal of Tropical Pediatrics - current issue

Journal of Tropical Pediatrics Current Issue





Published: Fri, 08 Dec 2017 00:00:00 GMT

Last Build Date: Fri, 08 Dec 2017 14:53:57 GMT

 



In this Issue 63/6

Fri, 08 Dec 2017 00:00:00 GMT




Goodbye Paper: We are Moving to Online Only Publication

Fri, 13 Oct 2017 00:00:00 GMT

The Journal of Tropical Pediatrics (JTP) will move to online-only publication from January 2018; the sixth 2017 edition will be the last printed issue. The Editors and publishers of JTP have taken this decision in the light of the extensive online usage of the journal and that fact that we are now supplying few print subscribers with copies of the journal.



Accuracy of New Ballard Score in Small-for-gestational Age Neonates

Thu, 27 Jul 2017 00:00:00 GMT

Abstract
Objective
The aim of this study was to evaluate the performance of New Ballard Score (NBS) in small-for-gestational age (SGA) neonates.
Methodology
Neonates born at 35–40 weeks of gestation were included if accurate obstetric gestation estimate was available and birth weight was <10th percentile for gestation. Gestation-matched appropriate-for-gestational-age neonates were enrolled as controls. Gestation derived from NBS was compared with gestation calculated from last menstrual period.
Results
Gestational age estimated by NBS was significantly higher in SGA neonates (mean difference: 0.7 weeks). Neuromuscular component score was similar but physical component score was significantly higher in SGA neonates. Reanalysis after reducing score of 4 to 3 of SGA babies for skin and plantar crease physical parameters showed overestimation of gestational age decreased to 0.4 weeks.
Conclusions
The physical parameters of NBS overestimate gestation in SGA neonates. Changing scores of skin and plantar creases in SGA neonates better estimates gestation age.



Analgesic Efficacy of Oral Dextrose and Breast Milk during Nasopharyngeal Suctioning of Preterm Infants on CPAP: A Blinded Randomized Controlled Trial

Wed, 22 Mar 2017 00:00:00 GMT

Abstract
Continuous positive airway pressure (CPAP) requires nasopharyngeal suctioning for airway patency, which is painful. Other procedures have used breast milk and 25% dextrose as analgesics. We aimed to compare their analgesic efficacy during nasopharyngeal suctioning in preterm neonates on CPAP. In this blinded randomized controlled trial, babies received 25% dextrose or breast milk orally. Pain before, during and after was assessed using the Premature Infant Pain Profile (PIPP) score. Analysis was done for 40 babies. The mean PIPP score in the 25% dextrose group during the procedure was 11.25 ± 2.73 and 13.2 ± 2.55 (p = 0.02) with the intervention and without. In the breast milk group the PIPP score during the procedure was 11.35 ± 3.05 and 13.45 ± 3.27 (p = 0.04); this difference persisted even after the procedure. There was no significant difference between the interventions. Both interventions significantly reduce pain. The analgesic effect of breast milk was sustained.



Construction of Ductal Diameter Centiles in the First 24 h of Life and Their Relation to Cerebral Blood Flow in Neonates Weighing Less Than 1250 g in the First 24 h of Life

Mon, 13 Mar 2017 00:00:00 GMT

Abstract
Aims and objectives
To evaluate the ductal diameter centiles in the first 24 h of life and their relation to cerebral blood flow in neonates weighing <1250 g in the first 24 h of life.
Method and material
This prospective observational cohort study enrolled 44 infants with birth weight <1250 g. Two-dimensional echocardiography and color Doppler were performed within the first 12 h of life and were repeated again in the next 12 h of life to assess the ductal size and middle cerebral artery (MCA) flows [peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI)].
Results
The mean patent ductus arteriosus (PDA) size (mm) within 0–6 h was 1.88 ± 1.12, within 7–12 h was 2.02 ± 0.973, within 13–18 h was 1.47 ± 1.00 and within 19–24 h was 1.42 ± 0.705. There was a significant increase in the PSV and MV of the MCA in infants with open PDA compared with those with closed PDA (p < 0.05) when measured between 13 and 24 h of life. There was no correlation between the PDA size and simultaneous PSV, EDV, MV and PI of MCA within 12 h of life. The PDA size within 13–24 h showed correlation with only the PSV of the MCA (p = 0.05) and not with the EDV, MV and PI. There was no significant difference in the PSV, EDV, MV and PI among the infants depending on the size of the PDA.
Conclusion
There is a progressive decrease in the PDA size in the first 24 h of life. The PSV and MV of the MCA are increased in infants with closed PDA, but among those with open PDA, size does not relate to MCA flows in the first 24 h of life.



The Challenge of Assessing Microcephaly in the Context of the Zika Virus Epidemic

Fri, 10 Mar 2017 00:00:00 GMT

Abstract
The present article examines the impact of the current limitations of the microcephaly definition in the context of the Zika virus outbreak. It highlights its dependence on the method used for determining gestational age and other anthropometric parameters, and includes original results of prevalence of microcephaly in four countries from two different continents (Mozambique, Brazil, Guatemala and Colombia). Alternative definitions of microcephaly are proposed to allow the identification of true cases of microcephaly in a more accurate manner.



Recent Trends in Body Mass Index and Waist Circumference among Children and Adolescents in Shandong China

Wed, 08 Mar 2017 00:00:00 GMT

Abstract
Background
The present study examined the recent trends in body mass index (BMI) and waist circumference (WC), and the prevalence of general and abdominal obesity among children and adolescents in Shandong, China.
Methods
Data for this study were obtained from two cross-sectional surveys of schoolchildren carried out in 2010 and 2014 in Shandong Province, China. A total of 72 755 students aged 7–18 years were included in this study. The BMI cutoff points recommended by the International Obesity Task Force were used to define overweight and general obesity. Abdominal obesity was defined as waist-to-height ratio (WHtR) ≥ 0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, abdominal obesity only and combined obesity.
Results
For both boys and girls, an increasing trend in BMI and WC was observed between 2010 and 2014 (p < 0.01), WC has increased faster than BMI. The sum of the prevalence of the three types of obesity increased from 16.63% (boys) and 8.13% (girls) in 2010 to 20.37% (boys) and 11.61% (girls) in 2014 (p < 0.01).
Conclusion
WC and abdominal obesity increased faster than BMI and general obesity among children and adolescents between 2010 and 2014. This study also suggested that distinguishing the types of obesity and examining the prevalence of various types of obesity are useful in practice.



Changing Knowledge and Practices of Mothers on Newborn Care through Mother Class: An Intervention Study in Indonesia

Fri, 03 Mar 2017 00:00:00 GMT

Abstract
Poor knowledge and practices of newborn care may contribute to high neonatal mortality. This study aims to analyze the effect of prenatal education, namely ‘mother class’, on knowledge and practices of newborn care among mothers in Tangerang Selatan District, Indonesia. An intervention study with a quasi-experimental design was conducted. Using a questionnaire, 427 mothers were interviewed: an intervention group (n = 214) that attended mother class and a control group (n = 213) that had not. A home visit followed the intervention to assess newborn care practices. Mother class used Maternal and Child Health Handbook as the main reference material. Attending mother class significantly increased knowledge of breastfeeding initiation and hepatitis B immunization (p < 0.05). Mothers in the intervention group had the likelihood of practicing good newborn care compared with the control group (odds ratio: 1.812; 95% confidence interval: 1.235–2.660). Mother class improves knowledge and newborn care practices and strengthens interactions between mothers and health care providers.



Causes and Predictors of Neonatal, Post-neonatal and Maternal Deaths in India: Analysis of a Nationwide District-Level Household Survey-4 (DLHS-4), 2012–13

Thu, 02 Mar 2017 00:00:00 GMT

Abstract
Introduction
There is lack of reliable mortality estimates in India about maternal, neonatal and infant deaths. As we move towards achieving the targets under Sustainable Development Goals, information on cause of death is essential to prioritize our resources and planning. Therefore, the present study describes the causes and characteristics of neonatal, post-neonatal and maternal deaths in India.
Methods
The study analysed nationwide District-Level Household Survey-4 conducted by the Ministry of Health and Family Welfare, Government of India, in 2014. The household questionnaire collected information on the socio-economic characteristics of the household and deaths within the household, including neonatal, post-neonatal, maternal and adult deaths.
Results
Of 1324 neonatal deaths, 46% occurred at home and 73% in the first week of life. Among 2032 post-neonatal deaths reported, 70% occurred at home. Birth injuries, low birth weight and neonatal infections were the leading causes of neonatal deaths. Acute respiratory infection was the most common cause of post-neonatal deaths, whereas excessive bleeding and pregnancy-induced hypertension were the common causes of maternal deaths. Nearly 39% of neonatal and 50% of post-neonatal deaths were either classified as others or could not be ascertained. Household characteristics such as use of unclean fuel, poor sanitation, poor drinking water source, type of house (kachha) and below poverty line family are associated with mortality.
Conclusion
A high proportion of avoidable deaths still occur at home. These findings indicate the need for an efficient ambulance transport system, promoting health-seeking behaviour, better knowledge of danger signs and strengthening community–facility linkages. A more accurate verbal autopsy tool and proper administration of the tool are required to accurately ascertain cause of death and reduce the number of deaths that are assigned an ill-defined cause.



Mycoplasma hominis, Ureaplasma urealyticum and Chlamydia trachomatis Respiratory Colonization in Malaysian Preterm Infants

Thu, 02 Mar 2017 00:00:00 GMT

Abstract
This prospective observational study aims to determine the incidence, predictors and clinical features of Mycoplasma hominis (MH), Ureaplasma urealyticum (UU) and Chlamydia trachomatis (CT) respiratory colonization in infants <37 weeks of gestation. A total of 200 preterm newborns admitted to a tertiary center in Malaysia between 2013 and 2015 for increased breathing effort had their respiratory secretions tested for these bacteria by polymerase chain reaction. Fifteen of the 200 (7.5%) infants were detected to have these organisms in their respiratory tracts. Preterm prelabor rupture of membrane was associated with positive detection (odds ratio: 3.7; 95% confidence interval: 1.2–11.3). Seventy-three of the 200 (36.5%) infants were given macrolide for presumed infection but only 4.1% (3 of 73) were positive for these organisms. The incidence of UU respiratory colonization among preterm infants in our center is lower than other published reports, while the frequency of MH and CT isolation is comparable with many studies. There should be judicious use of empirical antibiotics for presumed UU, MH and CT infection in preterm infants.



Full Volume Isotonic (0.9%) vs. Two-Thirds Volume Hypotonic (0.18%) Intravenous Maintenance Fluids in Preventing Hyponatremia in Children Admitted to Pediatric Intensive Care Unit—A Randomized Controlled Study

Thu, 02 Mar 2017 00:00:00 GMT

Abstract
Background
We aimed to compare the effect of two different intravenous fluid regimes on the incidence of hyponatremia in children.
Methods
Children 1 month to 18 years of age, admitted to pediatric intensive care unit (PICU) of a tertiary care medical college hospital were randomized to receive either isotonic fluid (0.9% saline in 5% dextrose) at the standard maintenance rate or hypotonic fluid (0.18% saline in 5% dextrose) at two-thirds of the standard maintenance rate.
Results
A total of 240 children were randomized (120 isotonic, 120 hypotonic). In all, 16.7% children in hypotonic group developed hyponatremia compared with 7.5% in isotonic group (p = 0.029). Duration of PICU stay was significantly more in Hypotonic group.
Conclusion
We conclude that use of 0.9% saline in 5% dextrose as maintenance fluid helps in reducing the incidence of hospital-acquired hyponatremia and duration of intensive care unit stay among children admitted to PICU.



Comparative Evaluation of Norovirus Infection in Children with Acute Gastroenteritis by Rapid Immunochromatographic Test, RT-PCR and Real-time RT-PCR

Thu, 02 Mar 2017 00:00:00 GMT

Abstract
Immunochromatographic (IC) test for norovirus detection is a rapid and simple detection method. This study evaluated the sensitivity and specificity of a recent version of R-Biopharm RIDA®QUICK Norovirus IC assay for norovirus detection in fecal specimens from children hospitalized with acute gastroenteritis. Fecal specimens were tested by IC kit in comparison with gold standard reverse transcription polymerase chain reaction (RT-PCR) and real-time RT-PCR. The IC kit showed high sensitivity and specificity comparable with PCR-based methods. None of false positive and false negative was found and the assay did not cross-react with other gastroenteritis viruses. The IC assay could detect genogroup I.5 (GI.5) and a wide range of genotypes in the GII noroviruses including GII.3, GII.4, GII.6, GII.7, GII.14, GII.15, GII.21, and also newly emerging GII.17 norovirus. In conclusion, this norovirus IC kit could be an alternative choice for rapid screening or a quick diagnostic tool for norovirus detection in fecal specimens of acute gastroenteritis patients.



Subcutaneous Emphysema of Scalp following Resuscitation in a Neonate

Tue, 21 Feb 2017 00:00:00 GMT

Abstract
Background: Neonatal subcutaneous emphysema of scalp (SES) with air leaks is rare. Case characteristics: Neonate presented with SES in addition to pneumothorax and pneumomediastinum. Observation: SES resolved after the chest was drained to treat pneumothorax. Outcome: Neonate made full recovery. Conclusion: Neonatal SES may be associated with air leaks post-resuscitation, which has not been reported.



Neurocognitive Function of School-aged HIV-infected Children in Enugu, Nigeria

Mon, 20 Feb 2017 00:00:00 GMT

Abstract
Background
Evidence has shown neurocognitive problems often exist among human immunodeficiency virus (HIV)-infected children. There are limited data for children in Nigeria.
Methods
This was a cross-sectional study of 100 school-aged perinatally HIV-infected children seen in the paediatric HIV clinic and age/sex-matched controls from the general paediatric clinic. Neuro-cognitive functioning was assessed using the Raven’s progressive matrices (RPM) that has been adapted for the Nigerian population.
Results
The mean RPM score of subjects was 22.97 ± 11.35 compared with 32.93 ± 15.71 among controls (p < 0.001). Twenty-two percent of subjects in the HIV-infected group vs. 56% of controls were in the above-average intelligence group on the RPM. Thirty-four percent had average scores, while 22% were in the below-average scoring range. Neuro-cognitive functioning of the subjects was significantly affected by immunologic staging and socio-economic status.
Conclusions
Neurocognitive functioning of the HIV-infected children was significantly lower than those of their un-infected counterparts. Neurodevelopmental evaluation should be part of standard care in HIV-infected children in Nigerian setting.



A Randomized Controlled Trial to Evaluate the Role of Brief Delay in Cord Clamping in Preterm Neonates (34–36 weeks) on Short-term Neurobehavioural Outcome

Wed, 15 Feb 2017 00:00:00 GMT

Abstract
The effects of a brief delay in cord clamping on the neurobehaviour of late preterm infants are largely unknown. It is hypothesized that a brief delay in cord clamping will have beneficial effects on the neurobehavioural outcome of such neonates.
Aim
To study the effect of brief delay in cord clamping on short-term neurobehavioural outcome of preterm neonates.
Methods
All preterm neonates born between 34–36 weeks and 6 days were included and randomized into either a control or intervention group. In the control group, clamping was done within 20 s after delivery, and this was termed as immediate cord clamping (ICC). In the intervention group, delayed cord clamping (DCC) took place between 30 and 60 s. A total of 120 preterm neonates were enrolled. The primary outcome studied was short-term neurobehavioural outcome at 37 weeks after conceptional age using the Neurobehavioral Assessment of Preterm Infants (NAPI) score as the outcome measure.
Results
NAPI scores at 37 weeks of corrected gestational age revealed a mean (95% confidence interval) score of motor development and vigour of 64.21±27.31 (57.27 − 71.14) vs. 76.69±25.29 (70.04–83.34), p= 0.01; and alertness and orientation of 29.31±12.78 (26.06–32.55) vs. 42.77±15.75 (38.63–46.91), p= 0.00 across the ICC vs. DCC groups, respectively.
Conclusion
A brief delay of 30–60 s in cord clamping is beneficial in improving neurobehavioural outcome of late preterm infants.