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Journal of Tropical Pediatrics Current Issue





Published: Fri, 27 Jan 2017 00:00:00 GMT

Last Build Date: Sat, 28 Jan 2017 03:45:27 GMT

 



In this Issue 63/1

2017-01-27




Neonatal Sepsis in Haiti

2016-10-19

Abstract
Infections (including sepsis, meningitis, pneumonia and tetanus) stand as a major contributor to neonatal mortality in Haiti (22%). Infants acquire bacteria that cause neonatal sepsis directly from the mother’s blood, skin or vaginal tract either before or during delivery. Nosocomial and environmental pathogens introduce further risk after delivery. The absence of cohesive medical systems and methods for collecting information limits the available data in countries such as Haiti. This study seeks to add more information on the burden of severe bacterial infections and their etiology in neonates of Haiti. Researchers conducted a secondary retrospective analysis of a de-identified database from the Neonatal Intensive Care Unit (NICU) at Nos Petit Frères et Soeurs-St. Damien Hospital (NPFS-SDH). Records from 1292 neonates admitted to the NICU at NPFS-SDH in Port-au-Prince Haiti from 2013 to 2015 were reviewed. Sepsis accounted for 708 of 1292 (54.8%) of all admissions to the NICU. Infants admitted for sepsis had a mortality rate of 23% (163 of 708 infants admitted for sepsis). The most common organism cultured was Streptococcus agalactiae, followed by Klebsiella pneumoniae, Pseudomonas aeroginusa, Enterobacter aerogenes, Staphylococcus aureus and Proteus mirabillis. Failure to order or obtain a culture was associated with an increased fatality (odds ratio 2.4) for infants with sepsis. Resistance should be a concern when treating empirically.



The Importance of Interventions to Improve Maternal Mental Health

2016-10-06

Improving maternal mental health is a global public health priority [1–5]. Perinatal maternal depression, defined by at least one depressive episode from pregnancy through the first postnatal year, has negative health effects for both the mother and the child. For mothers, these include high levels of physical ill health, early mortality and impairment of activities of daily living [6, 7]. Effects on children include poor growth and nutrition, increased physical morbidities, impaired neurodevelopment and behavioural problems [8–13]. Overall, mothers need to be physically and mentally healthy to provide effective and responsive care for their children. Worldwide, between 10 and 35% of children are exposed to perinatal depression in their first year of life [14].



Vitamin D Status, Latitude and their Associations with Some Health Parameters in Children: National Food and Nutrition Surveillance

2016-09-04

Abstract
Background: Recent data indicate a role for vitamin D in many health aspects including anthropometric measures and blood lipid profiles. Dermal vitamin D synthesis may be influenced by latitude. However, the contribution of latitude in vitamin D status and its association with anthropometric and blood lipid measures in Iranian children have not been studied to date.Methods: We used data from the National Food and Nutritional Surveillance Program. In total, 667 apparently healthy children aged 5–18 years were randomly selected from six provinces of Iran with different latitudes, from 29 to 37°. Weight, height, circulating 25-hydroxycalciferol; calcidiol [25(OH)D] and blood lipids were measured.Results: In total, 16.7 and 4.1% of children were overweight or obese, respectively. The mean 25(OH)D concentration was 27.3 ± 17.6 nmol/l (95% confidence interval: 26.0–28.7 nmol/l). Over 93% of all children had suboptimal circulating calcidiol concentrations. Undesirable status of vitamin D, serum triglyceride and low-density lipoprotein were all more prevalent in children living in regions  >33° latitude than those in  <33°, significantly. There was no significant difference in duration of sun exposure between children living in latitudes below and above 33° (p = 0.093). In multivariate regression model, sex, latitude, body mass index for age z-score and sun exposure duration were independently related to 25(OH)D concentrations, but age was not.Conclusion: Despite significant association of latitude and vitamin D status, hypovitaminosis D is prevalent across latitude gradient in Iranian children. Our findings warrant immediate sustainable nutritional intervention, including supplementation, to protect children from hypovitaminosis D irrespective of the latitude of their residence.



A Survey of Practice and Knowledge of Refugee and Migrant Pregnant Mothers Surrounding Neonatal Jaundice on the Thailand–Myanmar Border

2016-08-29

Abstract
Background: In populations with a high prevalence of glucose-6-phosphate dehydrogenase deficiency, practices that can induce haemolysis need to be identified to raise awareness of preventable risks. The aim of this survey was to determine the proportion of prospective mothers using haemolytic agents and their knowledge and practice surrounding neonatal jaundice.Methods: Pregnant mothers were invited to participate in a cross-sectional survey conducted at Shoklo Malaria Research Unit on the Thailand–Myanmar border.Results: From 12 April 2015 to 12 June 2015, 522 pregnant women completed the survey. Mothball use in the household was reported by 41.4% (216 of 522) of prospective mothers and menthol containing products on baby skin by 46.7% (244 of 522).Conclusion: Just over 40% of the households reported use of naphthalene-containing mothballs. Future health promotion activities that focus on reducing naphthalene mothball and menthol-containing products use have the potential to reduce rates of severe neonatal jaundice in this population.



Prevalence of Anemia and its Risk Factors among Children under 36 Months Old in China

2016-08-19

Abstract
This study aims to evaluate the prevalence and sociodemographic factors of anemia in children <36 months old in China. In this study, data of 24 235 children were investigated from 32 primary health care (PHC) facilities in 11 province-level regions. Pearson χ2-test and logistic regression model were used to estimate potential risk factors associated with anemia. The overall prevalence of anemia was 24.4%, and 32.8% children from rural areas were anemic, but no statistically significant difference was observed between male and female. Predictors of anemia are different regions of China, cesarean delivery, premature birth and neonatal asphyxia. We also found that education level and income of children’s parents are important determinants of childhood anemia. In additional, feeding practice would affect anemia among children aged 6–12 months. Our results could provide some insights for prevention and control of childhood anemia in PHC facilities.



Acquired Immune Deficiency Syndrome in Differential Diagnosis of Hyper-IgE-Immunoglobulinemia: Pediatric Case Report

2016-08-10

Abstract
Acquired immune deficiency syndrome can be encountered with hypereosinophilia and hyperimmunoglobulin E (hyper-IgE) values, though these levels are rarely so high to be compared with hyperimmunoglobulin E syndrome. A 9-year-old boy presented with the complaint of fatigue, weakness, weight loss and generalized pruritic rash lasting for a year. He had frequent respiratory tract infections, wheezing episodes and urticarial skin lesions before that. On admission, he was cachectic and he had generalized lymphadenopathy, hepatosplenomegaly, oral moniliasis and pruritic rash all over his body. Laboratory evaluation revealed marked lymphopenia and hypergammaglobulinemia with extremely high IgE values (IgE: 59 300 kU/l). He was diagnosed with stage 4 human immunodeficiency virus (HIV) infection and started on antiretroviral treatment. In conclusion, HIV infection can be presented with increased IgE values.



Epidemiology, Clinical and Laboratory Features and Course of Chikungunya among a Cohort of Children during the First Caribbean Epidemic

2016-08-10

Abstract
This study describes the epidemiology, the clinical features and the course of confirmed chikungunya among a cohort of children. It is a prospective audit of chikungunya cases among children registered for routine medical care at a primary care center. Children presenting with suspected chikungunya were confirmed using real-time reverse transcription polymerase chain reaction. There were 203 suspected cases of chikungunya; of these, 115 samples were tested and 69 (59.0%) were confirmed. The attack rate of chikungunya was 10.2% and 3.5% for the suspected and confirmed cases, respectively. Only six (8.7%) of the children with confirmed chikungunya required hospitalization. Joint pain was a clinical feature in 68 of 69 (98.6%) and skin rash was seen in 32 (46.4%) confirmed cases. The duration of illness was <2 weeks in 89.9% and less than a week in 62.3% of cases. In conclusion, most children had mild clinical manifestations and recovered fully within 2 weeks.



Bilateral Idiopathic Carpal Tunnel Syndrome in a 4-Year-Old Girl

2016-07-31

Abstract
Carpal tunnel syndrome (CTS), the most common entrapment neuropathy in adulthood, is rare in childhood. The symptoms may differ to those in adults, or may be misinterpreted owing to children’s difficulties in expressing themselves. Cases of idiopathic, bilateral CTS under the age of 5 are rare. A 4-year-old girl presented with pain in both hands and difficulty opening them in the morning. Bilateral severe CTS was determined at electroneuromyography (ENMG). Bilateral wrist splints were advised for both hands. Improvement in ENMG was seen at 2 weeks following conservative treatment.



Clinical Anaemia Detection in Children of Varied Skin Complexion: A Community-based Study in Southeast, Nigeria

2016-07-22

Abstract
Background: Clinicians rely on clinical detection of pallor to diagnose anaemia. This makes it important to evaluate the effect of different skin complexions on the accuracy of the pallor in diagnosing anaemia in children. Methods: Clinicians conducted blind-independent physical examination, and their reports were compared with HemoCue 301 haemoglobin estimated with. The sensitivity and specificity were calculated. Results: A total of 573 children were reviewed by 27 healthcare workers. The prevalence of anaemia was high. The highest prevalence was among children between the age of 4 and 12 months (urban 63.4% and rural 69.2%). Anaemia was detected better among dark-skinned children. Conjunctivae and palm pallor had the highest sensitivity (78.6% and 69.2%, respectively). Discussion: Clinical pallor is a good screening assessment for anaemia but not diagnostic. Its sensitivity and specificity vary among different sites and skin complexions. Thus combining findings at any of the sites can improve detection of anaemia in children.



Concurrent Autochthonous Malaria Caused by Plasmodium vivax in Father and Son in Greece

2016-07-18

Abstract
We report the case of a 12-year-old child who was admitted to our Department, with 7 days’ history of high fever and splenomegaly. His father had similar symptoms starting on the same day. A rapid test and microscopy for malaria yielded a positive result for Plasmodium vivax. Antimalarial therapy was initiated. He developed methemoglobinemia treated with ascorbic acid and had uneventful recovery.



Comparison of the Efficacy of Oral 25% Glucose with Oral 24% Sucrose for Pain Relief during Heel Lance in Preterm Neonates: A Double Blind Randomized Controlled Trial

2016-07-18

Abstract
Aim: To study the analgesic effect of oral 25% glucose as compared with oral 24% sucrose during heel lance in preterm neonates. Methods: Stable preterm neonates within first 48 hours of life were randomized to receive either 24% sucrose or 25% glucose before heel lance. Primary outcome assessed was painful response by the Premature Infant Pain Profile (PIPP) score at 30 seconds after heel lance, and the secondary outcome was immediate adverse events associated with the administration of two solutions and duration of crying immediately following the procedure. Results: A total of 94 neonates were randomly assigned into 24% sucrose and 25% glucose group. The baseline characteristics between the two groups were comparable. No significant difference was observed between the two study groups with respect to PIPP scores, duration of crying and rate of adverse events. Conclusions: When assessed by PIPP score, 25% glucose and 24% sucrose provided comparable analgesia during heel lance in preterm neonates.



Transcutaneous Bilirubin Levels during the First Month of Life in Term and Late-preterm Newborns

2016-07-07

Abstract
Objective: We aimed to develop a transcutaneous bilirubin (TcB) nomogram for assessment of the risk of significant hyperbilirubinemia and prolonged jaundice during the first month of life in term and late-preterm Turkish newborns.Methods: On the basis of the daily (3rd, 7th, 15th and 30th days) TcB measurements, 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles, and 5 percentile tracks were obtained. TcB measurements were made by a transcutaneous bilirubinometer (JaundiceDetector JH20-1C).Results: We screened 729 healthy term and late-preterm Turkish infants 3–30 days old and developed a nomogram of TcB levels. TcB level was ≥5 mg/dl in 41.98% and 25.9% of infants at age 15.0  ±  2.1 days and 30.9  ±  2.6 days, respectively. The TcB measurement-based nomogram values of the 97th percentiles (cutoff values) at age 15.0  ±  2.1 and 30.9  ±  2.6 days were 11.4 (10.82–12.13) mg/dl and 10.0 (9.40–10.70) mg/dl, respectively.Conclusion: This nomogram can be used to determine the risk status of Turkish newborns regarding significant hyperbilirubinemia and prolonged jaundice on the basis of TcB measurement in the first month of life.



No Reduction in Hemoglobin Level in Severe Plasmodium falciparum Malaria Treated with Artesunate in Central Sudan

2016-06-30

Abstract
Background: There are few publications on anemia following artesunate treatment. Objective: To investigate the hemoglobin in patients with severe Plasmodium falciparum malaria treated with artesunate or quinine. Methods: Patients with P. falciparum (in Singa, Sudan) were treated by intravenous artesunate or quinine. Hemoglobin was measured initially, at day 14 and day 28. Results: The mean (SD) of the age was 10.3 (10.9) years. The two groups (61 in each arm) were matched in their basic characteristics. Hypotension, convulsions, severe anemia were the main presentations. There was no significant difference in the mean (SD) hemoglobin level at the initial day, day 14 and at day 28 [11.2 (1.8), 11.3 (1.6), 11.5 (1.8), p = 0.170], respectively, in both groups. The hemoglobin did not change significantly from the baseline in any of the group separately. Conclusion: There was no difference in hemoglobin concentration in patients with severe malaria after treatment with either artesunate or quinine.



Use of Camphor and Essential Oil Balms for Infants in Cambodia

2016-06-30

Abstract
Balms and oils containing terpenic compounds, such as camphor, menthol and eucalyptus, are potentially toxic, and numerous reports of adverse events stemming from their use in infants and young children have been published. During qualitative research on newborn practices in rural Cambodia, these products were found to be commonly applied to the skin of newborns and infants and available in most households. Parents and caregivers of infants in Cambodia and other settings where use of camphor- and menthol-containing products are common should be educated on the risks of these to prevent child morbidity and potential mortality.



Bovine Colostrum in Prevention of Necrotizing Enterocolitis and Sepsis in Very Low Birth Weight Neonates: A Randomized, Double-blind, Placebo-controlled Pilot Trial

2016-06-09

Abstract
Objective: To study the efficacy of bovine colostrum in prevention of necrotizing enterocolitis (NEC) and sepsis in very low birth weight (VLBW) infants.Study Design: Randomized, double-blind, placebo-controlled pilot trial. Participants: Neonates with birth weight ≤1500 g, gestation ≤32 weeks and postnatal age ≤96 h. Intervention: Enteral bovine colostrum or placebo, four times a day, till 21 days of life or discharge or death. Main outcome measures: Definite NEC. Secondary outcomes included sepsis, mortality and stool interleukin-6 (IL-6) levels.Results: Of the total 86 subjects (43 in each group), there were no statistically significant in the main outcome measures. In the colostrum group, there were trends toward higher stool IL-6 values and higher incidence of ileus and radiological signs of NEC.Conclusion: The use of prophylactic enteral bovine colostrum in VLBW infants shows a trend toward increased stool IL-6 and features of NEC. We were unable to detect clinical benefits.