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Preview: Journal of Tropical Pediatrics - current issue

Journal of Tropical Pediatrics Current Issue





Published: Mon, 31 Jul 2017 00:00:00 GMT

Last Build Date: Tue, 01 Aug 2017 05:45:51 GMT

 



In this Issue 63/4

2017-07-31







Infantile Tremor Syndrome and Subdural Hemorrhage in an Infant with Cystic Fibrosis

2017-02-23

Abstract
Cystic fibrosis (CF), an autosomal recessive disease with multi-system involvement, may present with bleeding in infancy owing to vitamin K malabsorption. Infantile tremor syndrome (ITS) is an obscure condition associated with vitamin B12 and other micronutrient deficiencies, described predominantly in Indian subcontinent. We describe an infant presenting with ITS and chronic subdural hemorrhage. He was subsequently diagnosed to have CF. The ITS and subdural hemorrhage is rarely reported in children with CF. In the background of increasing recognition of CF in Indian children, this case demonstrates a new association of this disease.






Challenges in neonatal transport in Jamaica: A resource-limited setting

2017-01-14

Abstract
Aim
This study aimed to determine challenges associated with neonatal transport in Jamaica, a resource-limited setting.
Methods
This was a prospective descriptive study of neonates transported to the University Hospital of the West Indies (UHWI) over a 15 month period. Data on the clinical status of the neonates before, during and at the end of transport, as well as on accompanying staff and equipment, were collected. Neonatal demographics, reason for transfer and outcome at 48 h and at discharge were also collected. Descriptive analyses were performed.
Results
Fifty neonates were transferred to the UHWI; the most common reason for transfer was for respiratory support [30 (60%)]. The most common mode of transport was by road ambulance [42 (84%)]. Seventeen (34%) neonates experienced at least one adverse event during transport. On arrival, 27 (54%) neonates required warming, 42 (84%) fluid resuscitation and 14 (28%) cardiopulmonary resuscitation (CPR). Eighteen (36%) neonates died. The need for CPR on arrival predicted mortality (odds ratio: 2.3, confidence interval: 0.01–0.75, p = 0.02). A lack of appropriate equipment and adequately trained personnel was also noted.
Conclusion
Ensuring pre-transport stabilization of neonates, the availability of adequately trained staff and the provision of appropriate equipment must be urgently addressed to improve the outcome of neonatal transport in resource-limited settings like Jamaica.



Prothrombin Time Prolongation was the Most Important Indicator of Severe Bleeding in Children with Severe Dengue Viral Infection

2017-01-06

Abstract
To determine the indicators of severe bleeding in children with severe dengue viral infection (DVI), the medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989–2011 were reviewed. Severe-bleeding DVI was defined as needing blood products transfusion owing to DVI-caused bleeding. Of the 238 children with severe DVI according to the World Health Organization 2009 criteria, 44 (18.5%) had severe bleeding, of whom 28 (63.6%) died. The international normalized ratio (INR) had high correlations with both transaminase enzymes (Spearman correlation, rs =0.67–0.69, p <0.01). Multivariate analysis found that patients who had dengue haemorrhagic fever (DHF) grade IV, platelets <20 000/mm3 and INR ≥ 1.5 had increased risk of severe bleeding with odds ratios (95% confidence intervals) of 3.4 (1.4, 8.6), 2.6 (1.1, 6.2) and 10.6 (4.0, 28.4), respectively. Blood products should be at hand in severe DHF children with high risk of severe bleeding.



Increased Serum Interleukin-10 but not Interleukin-4 Level in Children with Mycoplasma pneumoniae Pneumonia

2017-01-05

Abstract
Background
Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia in children, and it has been associated with wheezing. The aim of this study was to examine the serum level of interleukin (IL)-4 and IL-10 in children with Mycoplasma pneumoniae pneumonia (MPP) and to analyse them in relation to the presence of wheezing.
Methods
The study included 166 children with radiologically confirmed pneumonia. MP infection was confirmed by enzyme-linked immunosorbent assay (ELISA) serum MP-IgM and MP-IgG test and throat swab MP DNA with real-time polymerase chain reaction. Serum levels of IL-4 and IL-10 were measured using ELISA.
Results
There was no significant difference in serum level of IL-4 between children with MPP and those with non-MPP. Among children with MPP, we found similar level of IL-4 regardless of the personal and family history of allergy and asthma or the presence of wheezing. A significantly higher level of IL-10 was found in children with MPP than in children with non-MPP (32.92±18.582 vs. 27.01±14.100 pg/ml, p =0.022). Furthermore, wheezing children with MPP had a significantly higher level of IL-10 than children with MPP without wheezing (43.75±26.644 vs. 27.50±10.211 pg/ml, p=0.027).
Conclusion
Our results show significantly increased serum level of IL-10 in children with MPP, which was significantly higher in children with wheezing. These findings may suggest a role of IL-10 in the pathogenesis of MPP and in the occurrence of wheezing during acute MP infection.



Mother’s Recognition of and Treatment Triggers for Common Childhood Illnesses among Migrant Santal Tribe Living in Bhubaneswar, Odisha, India

2016-12-30

Abstract
Background
Accelerating reduction in infant and other child mortality rates calls for comprehensive child survival strategies. Early recognition of illness and timely seeking of treatment are critical elements to prevent child deaths, and cultural explanation for these care-seeking behaviours is important. The present article reports (i) mothers’ recognition of illness and (ii) triggers of treatment related to some childhood illnesses among a migrant tribal community living in Bhubaneswar city, India.
Methods
From the four tribal dominated slums, 175 Santal tribal households were selected based on the criteria, viz. (i) the family should have migrated within the past 12 years and (ii) having a child aged 0–14 years. Semi-structured interviews were conducted with mothers for data related to illnesses occurred to their youngest child during past 1 year.
Results
The recognition of illness was made based on multiple symptoms. Triggers of treatment and care-seeking behaviour vary from illness to illness. Usually people wait for 2–3 days after onset of any illness, expecting the symptoms to subside automatically. Late onset symptoms and severity trigger mother to take child for treatment.
Conclusion
Mothers were able to recognize the childhood illnesses. There was substantial delay in seeking care. Hence, provision of primary health care and health education-based interventions are needed to improve the mothers’ recognition and care-seeking behaviour.



An Innovative Air-Oxygen Blender for Continuous Positive Airway Pressure Support in Resource-Poor Locations: A Feasibility Study

2016-12-26

Abstract
Objectives
The objectives of this study are (i) to evaluate the feasibility of using an inexpensive air pump to maintain reliable oxygen concentration in a continuous positive airway pressure (CPAP) system and (ii) to evaluate whether an inexpensive air pump can maintain infant 02 sats >90%.
Methods
This prospective study, which included 19 babies in pilot phase and 90 during extension phase, was conducted at a neonatal intensive care unit in a resource-poor academic medical center in India. The intervention involved introduction of an air pump in the CPAP delivery system. Outcome measures were oxygen concentration in the air-oxygen blend and oxygen saturation of the study babies.
Results
Oxygen concentration at the outlets ranged between 56 and 70% and in the blend between 42 and 51%. Oxygen saturation ranged between 90 and 97%.
Conclusion
A simple and inexpensive air pump can work as a safe and effective oxygen blender.



Stroke in Pediatric Diabetic Ketoacidosis: Case Series

2016-12-24

Abstract
Diabetic ketoacidosis (DKA) can present with various neurological complications, but stroke is rare. Here, we present three children with recent-onset diabetes with DKA, two of them had deep coma not responding to standard DKA regimen and the third one had seventh nerve palsy noted after recovering from coma. Computed tomography scan of head showed hemorrhage in the area of midbrain in one patient and infarcts in two patients. In any child of DKA with severe neurological impairment, possibility of stroke should be entertained.



Factors Affecting the Target Oxygen Saturation in the First Minutes of Life in Preterm Infants

2016-12-24

Abstract
Background
The aim of this study was to describe the effect of factors on time to reach a pulse oxygen saturation (SpO2) level of 90% in preterm infants in the delivery room.
Methods
Preterm (<35 gestational age) infants who did not require supplemental oxygen were included in the study. Continuous recordings were taken by pulse oximetry during the first 15 min of life.
Results
Of 151 preterm infants, 79 (52.3%) were female and 126 (83.5%) were delivered by cesarean section. Target saturation level (≥90%) was achieved faster in preductal measurements. Mean times taken to have a preductal and postductal SpO2 level of 90% were significantly lower in preterm babies born by vaginal delivery, with umbilical arterial pH ≥ 7.20 and whose mothers were non-smokers during pregnancy.
Conclusions
Differences in achievement of target saturation level were influenced by multiple factors (birth way, probe location, maternal smoking and umbilical blood gas pH) in the delivery room during resuscitation of preterm babies.



Chronic Pruritus in an 18-Month-Old Male Infant Due to Anicteric Cholestasis

2016-12-12

Abstract
An 18-month-old male infant was referred to us with pruritus from 6 months of age. He was being managed as atopic eczema with emollients and antihistamines without any response to treatment. On examination, he was found to have extensive scratch marks, mild hepatomegaly and no icterus. Blood investigations were suggestive of anicteric cholestatic liver disease. Liver biopsy was suggestive of progressive familial intrahepatic cholestasis type 3. He showed symptomatic improvement after starting ursodeoxycholic acid and fat-soluble vitamins and is under follow up.



Clinical and Epidemiological Characteristics of Burkitt Lymphomas in Pediatric Patients from Two Defined Socioeconomic Regions in Mexico

2016-12-12

Abstract
We analyzed clinical and epidemiological characteristics of Burkitt lymphoma (BL) in two defined socioeconomic regions in Mexico: high socioeconomic region (HSER; with two political jurisdictions) and low socioeconomic region (LSER; with three jurisdictions). Of the 63 cases registered in the Childhood Cancer Registry (1996–2013), 45 (71.4%) were from HSER and 18 (28.6%) from LSER. The incidence was higher in the LSER (3.1 vs. 1.4 cases per million children/year). The sporadic form and Stages III/IV predominated in both regions. Only one post-renal transplant (HSER) was found. The male/female ratio was higher in the LSER (5.0 vs. 1.4). The peak incidence was in the 1–4 age group for LSER, and in the 5–9 age group for HSER. This difference in the sporadic BL by socioeconomic regions may be related to different exposure factors.



Weight-for-Height Z Score and Mid-Upper Arm Circumference as Predictors of Mortality in Children with Severe Acute Malnutrition

2016-12-12

Abstract
Background
Mortality associated with severe acute malnutrition (SAM) could be reduced by screening malnourished children for those most vulnerable to death. We compared the weight-for-height Z score (WHZ) and mid-upper arm circumference (MUAC) as predictors of mortality in children with SAM.
Methods
We conducted a retrospective study spanning over 8 years, using records of children aged 6–59 months, hospitalized for SAM and discharged alive or who died during hospitalization.
Results
Area under the curve was greater for MUAC [0.809 (95% CI, 0.709–0.911, p = 0.001)] than WHZ [0.649 (95% CI, 0.524–0.774, p = 0.032)]. MUAC predicted death better [sensitivity: 95.5%, specificity: 25.0%, positive likelihood ratio (PLR): 1.27, negative likelihood ratio (NLR): 0.18] than WHZ (sensitivity: 86.4%, specificity: 21.4%, PLR: 1.10, NLR: 0.64). Best MUAC and WHZ cut-offs for predicting death (10.3 cm and -4, respectively) were most accurate in infants aged <12 months, the former being more accurate.
Conclusion
MUAC predicts death better than WHZ in children with SAM.



Isoniazid Preventive Therapy among Children Living with Tuberculosis Patients: Is It Working? A Mixed-Method Study from Bhopal, India

2016-12-12

Abstract
Objective
We assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers’ and parents’ perspectives in Bhopal, India.
Methods
A mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents).
Results
Of 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation.
Conclusion
National TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT.