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Preview: Journal of Tropical Pediatrics - recent issues

Journal of Tropical Pediatrics - recent issues

Journal of Tropical Pediatrics - RSS feed of recent issues (covers the latest 3 issues, including the current issue)


In this issue 62/6


Assessment of Adequacy of Supplementation of Vitamin D in Very Low Birth Weight Preterm Neonates: A Randomized Controlled Trial


Objectives: To compare the effect of 400 IU and 1000 IU vitamin D for 6 weeks in very low birth weight preterm neonates.

Design: Randomized, double-blinded controlled trial in a teaching hospital.

Participants: Fifty very low birth weight preterm neonates.

Intervention: Vitamin D 400 IU/day (Group 1) or 1000 IU/day (Group 2).

Outcome measures: Change in serum calcium, phosphate, alkaline phosphatase (ALP), 25-hydroxy vitamin D (25-OHD), parathormone, incidence of skeletal hypomineralization and growth.

Results: After 6 weeks of supplementation, the mean serum calcium and 25-OHD levels were significantly higher (p < 0.001 each), while ALP and parathormone levels significantly lower (p < 0.001 each) in group 2. Skeletal hypomineralization was lesser and growth better in group 2.

Conclusion: Vitamin D supplementation in a dose of 1000 IU/day is more effective in maintaining serum calcium, phosphate, ALP, 25-OHD and parathormone levels with lower incidence of skeletal hypomineralization and better growth.

Is the WHO Guide on Essential Practice of Postpartum Newborn Care Used in a District Health Care Facility?


Background: It is unclear whether algorithms with evidence-based interventions are used in a setting where the work load is high and qualified staff is scarce to identify neonates with life-threatening conditions.

Methods: The nurse-midwives’ knowledge and opinion about the World Health Organization (WHO) guide on postpartum newborn care were assessed in a hospital in Tanzania before and after training. Their adherence to this guide was evaluated by analysing 100 neonatal records. Results: Before training, 44% of the nurse-midwives were familiar with the WHO guide. All nurse-midwives supported the implementation of the guide. In all, 21% of the postpartum record forms were fully completed. Risk factors for illness were missed in 27%. Conclusion: Nurse-midwives’ expertise in the WHO guide on postpartum newborn care cannot be taken for granted. The complexity of this guide demands expertise and makes its use time-consuming and thus its practicability disputable in a setting with limited resources.

A Community-based Study on Growth and Development of Under-Five Children in an Urbanized Village of South Delhi


Background: Optimal development of children in their early months and years has a bearing on their achievement levels later in life.

Objectives: To assess the socio-emotional and cognitive development in children 0–5 years and to find out the proportion of children having developmental delay and its associated factors.

Methods: A community-based cross-sectional study was carried out in 520 children in Delhi. Development was assessed using the Indian Council for Medical Research Development Screening Test.

Results: In all, 10.6% of children <5 years old were found to be developmentally delayed. Maximum number of children (10.1%) were found to have a delay in the do main of ‘hearing language, concept development’. Of all the factors, the strongest association was found with stunting, paternal education, alcohol abuse, attendance in anganwadi/playschool.

Conclusions: The study concludes that developmental delay is present in a sizable proportion of children <5 years of age and may be a significant factor in the overall achievement of life’s potential in them.

Association between the Specific UGT1A1 Promoter Sequence Variant (c-3279T>G) and Unconjugated Neonatal Hyperbilirubinemia


We investigated the association between c-3279T>G and unconjugated neonatal hyperbilirubinemia. In all, 141 neonates were recruited; 63 had hyperbilirubinemia necessitating treatment, and 78 with bilirubin < 7 mg/dl served as the control group. The frequency of occurrence of c-3279T > G allele was significantly higher in the hyperbilirubinemic (49.2%) than in the control group (25.6%). The homozygous (p = 0.001, OR = 17.7 and CI = 3.9–79.3) rather than the heterozygous state (p = 0.3, OR = 0.7 and CI = 0.3–1.6) was associated with hyperbilirubinemia. Among the hyperbilirubinemic group, comparison between the three genotypes, homozygous mutation, heterozygous mutation and the normal allele, revealed that the former was associated with significantly higher mean peak total serum bilirubin [mean ± standard deviation (SD): 33.7 ± 8.2, 26.9 ± 2.8 and 21± 2.7, respectively, p-value = 0.0001], higher bilirubin/albumin ratio (p = 0.000) and a longer duration of hospital stay (p = 0.001). Homozygous c-3279T > G mutation represents an important risk factor for the development of neonatal hyperbilirubinemia.

Efficacy and Safety of Saccharomyces boulardii in Acute Rotavirus Diarrhea: Double Blind Randomized Controlled Trial from a Developing Country


Objective: To study the efficacy and safety of Saccharomyces boulardii (SB) in acute childhood rotavirus diarrhea.

Methods: Children (3 months to 5 years) with WHO-defined acute watery diarrhea and stool rotavirus positive (n = 60) were randomized into intervention (n = 30) and control (n = 30) groups. The intervention group received SB (500 mg/day) for 5 days.

Results: The median duration (hours) of diarrhea was significantly shorter in the intervention group (60 vs. 89; 95% CI: –41.2 to – 16.8). A significantly shorter duration of hospitalization (74 vs. 91; 95% CI: –33.46 to – 0.54) was also seen in the intervention group, but no significant difference was seen for fever and vomiting. There was also no difference between the two groups in the proportion of children requiring parenteral rehydration and persistence of diarrhea lasting beyond day 7. There was no report of any adverse events.

Conclusions: The present trial showed that SB is effective and safe in acute rotavirus diarrhea.

Impact of Telemedicine in the Screening for Congenital Heart Disease in a Center from Northeast Brazil


Objectives: To describe the incidence of congenital heart disease before and after the establishment of a telemedicine screening program, in a reference center from Northeast Brazil.

Methods: This is a descriptive, retrospective and comparative study based on the institutional data from a reference center in perinatology for a period of 16 years. Institutional data were collected from a 16-year period (2001–15). Data were divided into two periods: prior to (2001–11) and after (2012–15) the establishment of a telemedicine screening program.

Results: After the implementation of the screening process, almost all kinds of heart disease showed a significant increase in their incidence (p < 0.05). With this, the incidence of major heart diseases approached those specified in developed regions.

Conclusion: The implementation of a screening process model for congenital heart diseases can change the context of patients with congenital heart diseases in poor regions.

Hematological Differences among Malaria Patients in Rural and Urban Ghana


Background: Scarce studies have addressed hematological differences of malaria in urban and rural regions.

Methods: Full or complete blood cell counts from 46 and 75 individuals (age range from < 1 to 92 years) with uncomplicated malaria infection living in urban (Accra) and rural (Dodowa) Ghana, respectively, were assessed. Sickle cell trait and patients were excluded from the study.

Results: Between overall groups, patients from Accra had significantly lower parasite count (p < 0.0001) and granulocyte number (p = 0.026). Children in Accra had a significantly lower parasitemia (p = 0.0013), hemoglobin (p = 0.0254), platelet count (p = 0.0148) and red blood cell levels (p = 0.0080) when compared with the children of Dodowa. In adults, mean cell hemoglobin (p = 0.0086) and parasite count (p < 0.0001) were significantly higher in Dodowa.

Conclusion: These results indicate that children living in urban setting may experience a greater anemic effect to malaria as compared with those living in a rural setting.

N-acetylcysteine in Cleistanthus collinus Poisoning: A Report of Two Cases in Children


Cleistanthus collinus, also known as Oduvanthalai in Tamil, is the most commonly encountered plant poison in southern India. The leaves are used for poisoning humans (suicide or homicide) and animals (cattle and fish) and as an abortifacient, especially in rural south India. Although this poisoning is commonly reported in adults, data regarding the use of N-acetylcysteine in pediatric poisoning is lacking. We report two previously healthy male siblings of pediatric age group who ingested the liquid extracted from crushed leaves of this plant given to them by their mother as a means of deliberate harm. Both patients developed distal renal tubular acidosis, with hypokalemia. The younger sibling also developed myocardial toxicity. Other significant findings noted include hypocalcemia, hypomagnesemia and elevated liver enzymes. Both patients received supportive care along with N-acetylcysteine infusion, and showed complete recovery within 10 days.

Acute Abdominal Pain as a Presenting Symptom of Beriberi in a Pediatric Patient


Vitamin B1 (thiamine) plays a fundamental role in the proper functioning of the nervous and cardiovascular systems and in glucose metabolism. Because of the inability of the human body to store large amounts of vitamin, continuous restoration through diet is necessary. In the pediatric population, thiamine deficiency has a broad spectrum of clinical presentations, making diagnosis difficult. In this article, we report the case of a 7-month-old child with thiamine deficiency presented with neurological symptoms and simulation of acute abdomen. The patient received thiamine replacement, which resulted in rapid reversal of metabolic alterations and significant improvement in the signs and symptoms. A detailed investigation of dietary history and careful nutritional assessment of every critically ill pediatric patient is necessary, regardless of the primary cause of hospitalization.

Histoplasma capsulatum Infection with Extensive Lytic Bone Lesions Mimicking LCH


Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Alarmingly High Incidence of Eosinophilia in Barabanki and Neighboring Districts of Eastern Uttar Pradesh: A Prospective Hospital-Based Study


Eosinophilia is very common among rural poulation in Barabanki and neighbouring districts with no access to hygienic mode of stool disposition. Significant proportions of these children are suffering from anemia, undernutrition, anorexia, pain abdomen, cough and hence long term morbidity. This adds to the DALY of a developing country like India. All these chronic problems are preventable and treatable with simple corrective steps of which the most important ones are access to safe drinking water and toilet. The present study was conducted to study clinical and laboratory profile of patients with eosinophilia and to identify possible causes

In this issue 62/5


Growth Characteristics of Contemporary School-age Nigerian Children


Objective: There are no locally derived growth charts in Nigeria, and so, health workers rely on international reference charts. We therefore compared the growth characteristics of 4350 school-age Nigerian children (SNC) (2243 girls, 2107 boys) (4–16 years) from three ethnic groups (Hausa, Igbo and Yoruba) to both the UK (UK 1990) and US (2000 CDC) reference data.

Results: Height of SNC was similar to international references at the start of school age and then started to decline. The decline appeared to peak at 15 years for boys and 13 years for girls. At all ages, sex, ethnicity and affluence, SNC were lighter than international references. There were significant differences in the prevalence of stunting, underweight and obesity among the three ethnic groups (p < 0.05).

Conclusion: There is a risk of over-diagnosing short stature and underweight if health workers continue to use growth charts derived from other geographical areas.

Paramyxovirus Infection: Mortality and Morbidity in a Pediatric Intensive Care Unit


Objectives: We investigated mortality and morbidity of patients admitted to a pediatric intensive care unit (PICU) with paramyxovirus infection.

Methods: A retrospective study between October 2002 and March 2015 of children with a laboratory-confirmed paramyxovirus infection was included.

Results: In all, 98 (5%) PICU admissions were tested positive to have paramyxovirus infection (respiratory syncytial virus = 66, parainfluenza = 27 and metapneumovirus = 5). The majority of admissions were young patients (median age 1.05 years). Bacteremia and bacterial isolation in any site were present in 10% and 28%, respectively; 41% were mechanically ventilated, and 20% received inotropes. The three respiratory viruses caused similar mortality and morbidity in the PICU. Fatality (seven patients) was associated with malignancy, positive bacterial culture in blood, the use of mechanical ventilation, inotrope use, lower blood white cell count and higher C reactive protein (p = 0.02–0.0005). Backward binary logistic regression for these variables showed bacteremia (odds ratio [OR]: 31.7; 95% CI: 2.3–427.8; p = 0.009), malignancy (OR: 45.5; 95% CI: 1.4–1467.7; p = 0.031) and use of inotropes (OR: 15.0; 95% CI: 1.1–196.1; p = 0.039) were independently associated with non-survival. March and July appeared to be the two peak months for PICU hospitalizations with paramyxovirus infection.

Conclusions: Infections with paramyxoviruses account for 5% of PICU admissions and significant morbidity. Patient with premorbid history of malignancy and co-morbidity of bacteremia are associated with non-survival. March and July appeared to be the two peak months for PICU admissions with paramyxoviruses.

Prevalence of Congenital Anomalies in a Secondary Care Hospital in South India: A Cross-Sectional Study


Objective: To study the prevalence and types of congenital anomalies that present at birth in a secondary-level hospital in South India and its contribution to perinatal mortality.

Materials and methods: A total of 36,074 births over 10 years, from 2003 to 2013, were studied for the prevalence of gross congenital malformations at birth. It was a descriptive, cross-sectional study using data from the birth register and available medical records.

Results: The incidence of birth defects was 12.5 per 1000 live births, with musculoskeletal disorders being the commonest, followed by craniovertebral anomalies. The prevalence of anomalies over the past 10 years has not shown any significant change (p= 0.555).

Discussion: The high prevalence of neural tube defects indicates the need for periconceptional folic acid supplementation and early detection of anomalies, which would help in timely management. Detection of musculoskeletal anomalies would help in counseling patients antenatally.

Impact of 20 Week Lifestyle Intervention Package on Anthropometric Biochemical and Behavioral Characteristics of Schoolchildren in North India


Background: Childhood obesity is a public health problem worldwide. There is convincing evidence that school-based interventions are effective in managing childhood obesity. However, the nature of interventions, its impact on prevention of obesity and how they work remain poorly understood. The primary objective of this study was to examine the impact of a multicomponent lifestyle intervention on weight and body mass index (BMI) of children in a school-based setting. Methods: It is a cluster randomized trial where four schools were randomly selected and allocated to intervention and control arm equally. Of the 462 schoolchildren selected, 201 were assigned to the intervention group and 261 belonged to the control group. Children in the intervention arm received a multicomponent lifestyle package. Primary outcome measures included anthropometric measurements (weight, BMI, skinfold thickness and waist and hip circumference), whereas secondary outcomes were biochemical parameters, physical activity and dietary intake. Results: Compared with controls and adjusting for age, sex and clustering within classes, children in the intervention group showed decrease in the weight by – 0.08 (–0.15 to – 0.00, p = 0.048) z-score units, waist circumference by – 0.14 (–0.25 to – 0.03, p = 0.01) and triceps thickness by – 0.35 (–0.47 to – 0.22, p < 0.001) z-score units; however, BMI showed no significant decrease. There was significant reduction in intake of energy, protein and fat but no to minimal reduction in biochemical parameters. Conclusion: A school-based lifestyle intervention package favorably affected anthropometric (weight, waist circumference and triceps and biceps thickness) and behavioral parameters. At least 20 weeks of healthy lifestyle promoting intervention package should be included in school curriculum in each academic year for sustainable impact and behavioral change to reduce the burden of lifestyle disorders.

A Valuable Tool in Predicting Poor Outcome due to Sepsis in Pediatric Intensive Care Unit: Tp-e/QT Ratio


Objective: To assess the feasibility of 12-lead electrocardiographic (ECG) measures such as P wave dispersion (PWd), QT interval, QT dispersion (QTd), Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in predicting poor outcome in patients diagnosed with sepsis in pediatric intensive care unit (PICU).

Methods: Ninety-three patients diagnosed with sepsis, severe sepsis or septic shock and 103 age- and sex-matched healthy children were enrolled into the study. PWd, QT interval, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were obtained from a 12-lead electrocardiogram.

Results: PWd, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were significantly higher in septic patients compared with the controls. During the study period, 41 patients had died. In multivariate logistic regression analyses, only Tp-e/QT ratio was found to be an independent predictor of mortality.

Conclusion: The ECG measurements can predict the poor outcome in patients with sepsis. The Tp-e/QT ratio may be a valuable tool in predicting mortality for patients with sepsis in the PICU.

Effect of Treatment of Premature Infants with Respiratory Distress Using Low-cost Bubble CPAP in a Rural African Hospital


Background: Kenya’s neonatal mortality rate remains unacceptably high, at 22 deaths per 1000 live births, with a third of those attributable to prematurity. Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in the premature neonate. Continuous positive airway pressure (CPAP) is a proven modality of therapy but is rarely used in low-resource settings. We report on the introduction of bubble CPAP (BCPAP), a low-cost method of delivering CPAP appropriate to our setting, by comparing survival-to-discharge before and after the technology was introduced.

Methods: The inpatient hospital records of all preterm infants (<37 weeks) diagnosed with RDS in the AIC Kijabe Hospital Nursery during two 18-month periods before and after the introduction of BCPAP (46 infants enrolled from 1 November 2007 to 30 April 2009 vs. 72 infants enrolled from 1 November 2009 to 30 April 2011) were reviewed. Differences in survival-to-discharge rates between the two time periods were analyzed.

Results: The survival-to-discharge rate was higher in Period 2 (after the introduction of BCPAP) than in Period 1 (pre-BCPAP) (85% vs. 61%, p = 0.007). Similarly, there were lower referral rates of preterm infants with RDS in Period 2 than Period 1 (4% vs. 17%, p = 0.037).

Conclusion: BCPAP has contributed significantly to favorable outcomes for preterm infants with RDS at AIC Kijabe Hospital. The use of this simple technology should be considered and studied for expansion to all hospitals in Kenya that care for preterm infants.

Factors Associated with Stunting among Pre-school Children in Southern Highlands of Tanzania


Background: Stunting is a major public health problem in Africa and is associated with poor child survival and development. We investigate factors associated to child stunting in three Tanzanian regions.

Methods: A cross-sectional two-stage cluster sampling survey was conducted among children aged 6-59 months. The sample included 1360 children aged 6-23 months and 1904 children aged 24-59 months. Descriptive statistics and binary and multivariate logistic regression analyses were used.

Results: Our main results are: in the younger group, stunting was associated with male sex (adjusted odds ratio [AOR]: 2.17; confidence interval [CI]: 1.52-3.09), maternal absence (AOR: 1.93; CI: 1.21-3.07) and household diet diversity (AOR: 0.61; CI: 0.41-0.92). Among older children, stunting was associated with male sex (AOR: 1.28; CI: 1.00-1.64), age of 4 and 5 (AOR: 0.71; CI: 0.54-0.95; AOR: 0.60; CI: 0.44-0.83), access to improved water source (AOR: 0.70; CI: 0.52-0.93) and to a functioning water station (AOR: 0.63; CI: 0.40–0.98) and mother breastfeeding (AOR: 1.97; CI: 1.18-3.29).

Conclusions: Interventions that increase household wealth and improve water and sanitation conditions should be implemented to reduce stunting. Family planning activities and programmes supporting mothers during pregnancy and lactation can positively affect both newborns and older siblings.

Use of palivizumab with other infection control measures to control respiratory syncytial virus outbreaks in neonatal care units


Objective: No guidelines exist on the use of palivizumab during outbreaks of Respiratory Syncytial Virus (RSV) in Neonatal Intensive Care Units (NICUs). We aimed to describe an outbreak of RSV in NICU settings and the role of palivizumab in controlling the outbreak.

Methods: The index case was a 30-day-old premature infant. During the outbreak, 13 cases of RSV were confirmed by RT-PCR. All infants in the NICU received palivizumab after RSV diagnosis.

Results: Of the 13 cases, seven were male; and the median (interquartile) of birth weight was 1585 (IQR: 1480-1705) g. All cases were premature under 34-weeks-gestation. Age at onset of disease varies between 10 and 160 days. Only four cases occurred after administering palivizumab and applying other infection control measures.

Conclusion: During nosocomial outbreaks of RSV, administration of palivizumab to all infants in NICU appears to be rational and may help contain outbreaks.

Distribution of Eschar in Pediatric Scrub Typhus


Background: Identifying an eschar in scrub typhus is useful for initiation of prompt and appropriate antibiotic therapy.

Methods: The distribution of eschars in all children <15 years of age admitted with confirmed scrub typhus over a 5 year period is described.

Results: Of 431 children admitted with scrub typhus, eschars were present in 176 (40.8%) children with the following distribution: head, face and neck, 33 (19.1%); axillae, 37 (21%); chest and abdomen, 21 (11.9%); genitalia, inguinal region and buttocks, 58 (33%); back, 8 (4.5%); upper extremities, 13 (7.4%); and lower extremities, 5 (2.8%). The commonest sites of eschars were scrotum (27 of 106; 25.5%) and axillae (15 of 106; 14.2%) in males and axillae (22 of 70; 31.4%) and groin (16 of 70; 22.9%) in females. Eschars were seen within skin folds in 100 of 176 (56.8%) children.

Conclusion: Children should be carefully examined for the presence of eschar especially in the skin folds of the genitalia, axillae and groin to make an early diagnosis of scrub typhus.

Irradiance Decay in Fluorescent and Light-emitting Diode-based Phototherapy Devices: A Pilot Study


We set out to determine the rate of decline of irradiance for fluorescent tube (FT) and light-emitting diode (LED) phototherapy devices in resource-limited settings where routine irradiance monitoring is uncommon. Irradiance levels (μW/cm2/nm) were measured weekly using BiliBlanket® II Meter on three FT-based and two LED-based phototherapy devices over a 19 week period. The two LED devices showed stable irradiance levels and did not require any lamp changes. The three FT-based devices showed rapid decline in irradiance, and all required three complete lamp exchanges approximately every 5–6 weeks. FT-based devices are associated with more rapid decline in irradiance to sub-therapeutic levels and require more frequent lamp changes than LED devices. Clinicians should be alert to the maintenance requirements of the phototherapy devices available in their settings to ensure efficacy of treatment.

Fatal Neonatal Peritoneal Candidiasis Mimicking Mucormycosis--A Case Report and Review of Literature


Candida species have been implicated as significant contributors to morbidity in the neonatal period and are associated with 25–50% of mortality in invasive neonatal candidiasis. Peritoneal candidiasis, being paucisymptomatic, cannot often be correctly identified in a preterm neonate. The correct approach to diagnosis of neonatal peritoneal candidiasis is taking into account the epidemiology along with a strong clinical suspicion and appropriate timely diagnostic interventions. We report a case of fatal neonatal peritoneal candidiasis which was misdiagnosed as mucormycosis.

In this issue 62/4


Perfusion Index--Bedside Diagnosis of Hemodynamically Significant Patent Ductus Arteriosus


Background: Patent ductus arteriosus (PDA) is a significant problem in preterm babies <34 weeks old. Echocardiogram (echo) is the gold standard for diagnosing PDA. Perfusion index (PI) using a pulse oximeter could aid in diagnosing a hemodynamically significant PDA (HsPDA).

Objective: To evaluate the accuracy of delta-PI (PI; pre-ductal – post-ductal PI) in diagnosing HsPDA in preterm babies <34 weeks old.

Design: Prospective analytical cross-sectional (observational) study.

Methods: Preterm infants <34 weeks old (n = 27) were enrolled in the study after parental consent. PI was calculated on Days 1 and 3. Babies are categorized into two groups—HsPDA and no HsPDA based on echo on Day 3.

Results: The mean gestational ages were 30.4 ± 1.9 (HsPDA) and 31.7 ± 1.6 weeks (no HsPDA), and birth weights were 1.23 ± 0.32 kg and 1.43 ± 0.34 kg, respectively (p > 0.05). Ten infants had HsPDA. The PI values in Groups A and B differed significantly on Days 1 and 3 (Day 1: 1.06 ± 0.3 vs. 0.54 ± 0.2 and Day 3: 1.11 ± 0.15 vs. 0.57 ± 0.3). The area under the receiver operating characteristic curve was significant for PI on Days 1 and 3. The PI > 0.85 on Day 1 and > 0.95 on Day 3 had a sensitivity and specificity of 80% and 94% and 80% and 88.2%, respectively, for diagnosing HsPDA.

Conclusion: PI is a useful, simple parameter, which could help in the assessment of PDA in preterm babies.

Assessment of Vitamin D Status and Response to Vitamin D3 in Obese and Non-Obese Iranian Children


Background: Obesity seems to be a critical issue nowadays because of its high prevalence and its adverse effects on health. There is some evidence indicating the relationship between obesity and lower serum 25-hydroxyvitamin D [25(OH)D] concentration. The aim of the present study was to examine serum 25(OH)D status of obese and non-obese Iranian children and compare their therapeutic response with identical oral vitamin D3 treatment.

Methods: In a non-randomized clinical trial, serum 25(OH)D level of 45 obese and 45 non-obese Iranian children aged 2–14 years was measured. Those with serum 25(OH)D status <30 ng/ml (73 cases) were treated with one pearl of vitamin D3 (50 000 International Units) once a week for 6 weeks. Serum vitamin D was measured once more 2 weeks after treatment.

Results: The frequency of hypovitaminosis D was 43/45 (95.6%) in obese and 30/45 (66.7%) in non-obese children at baseline (p < 0.001). After treatment of 73 cases (43 obese, 30 non-obese), the above percentages were decreased to 24/43 (55.8%) and 1/30 (3.3%), respectively (p < 0.001).

Conclusion: Our study demonstrated a high frequency of vitamin D deficiency among Iranian children, particularly the obese ones. Moreover, low therapeutic response in the obese group is witnessed.

Clinical Severity and Rotavirus Vaccination among Children Hospitalized for Acute Gastroenteritis in Belem, Northern Brazil


In March 2006, Brazil introduced the monovalent rotavirus (RV) vaccine (Rotarix™) into the public sector. This study assessed the severity of rotavirus gastroenteritis (RVGE) according to the vaccination status among hospitalized children. We identified 1023 RVGE episodes among not vaccinated (n = 252), partially vaccinated (n = 156) and fully vaccinated (n = 615) children. Very severe gastroenteritis (scored ≥ 15) was reported in 16.7, 17.9 and 13.5% of not vaccinated, partially vaccinated and fully vaccinated children, respectively. There was a trend for a shorter duration of RV diarrhoea among vaccinated children than in not vaccinated children (p = 0.07). A protective effect of vaccination was noted when mean duration of symptoms and hospital stay are analysed, comparing unvaccinated, partially vaccinated and fully vaccinated children (p < 0.05). We showed a vaccination dose effect trend, with fully vaccinated children having less-severe RVGE than not vaccinated and partially vaccinated children.

The Burden of Child Maltreatment Leading to Hospitalization in a Provincial Setting in Papua New Guinea


 Introduction: Child maltreatment is prevalent globally. In Papua New Guinea (PNG), child maltreatment remains an under-reported problem.

Methods: As part of a 10 month prospective observational study conducted at Modilon Hospital in PNG, we investigated the burden of child maltreatment in the form of sexual abuse, physical abuse and neglect, leading to hospitalization in children ≤14 years.

Results: Of 1061 screened admissions, 107 (10%) fulfilled the definition of child maltreatment. The in-hospital admission prevalence of sexual abuse was 5.7% [60 of 1061; 95% confidence interval (CI): 4.4–7.3]. Neglect accounted for 3.4% (36 of 1061; 95% CI: 2.4–4.7) of admissions, while physical abuse accounted for 1.0% (11 of 1061; 95% CI: 0.6–1.9). Mortality was highest in the neglected group, with severe acute malnutrition accounting for 89% of deaths.

Conclusion: Improved awareness, establishment of appropriate channels for addressing child maltreatment and enforcement of child protection laws in PNG and other epidemiologically similar settings are urgently needed.

Flavored Intravenous Ondansetron Administered Orally for the Treatment of Persistent Vomiting in Children


Objective: To study the serum level of ondansetron after oral administration of intravenous ondansetron, and test the palatability of the drug after being flavored.

Method: This is a single-center prospective study enrolling children aged 3–8 years with gastroenteritis treated for persistent vomiting; patients received single dose of flavored intravenous ondansetron orally. The primary outcome was ondansetron serum level at 4 hours. Secondary outcome was palatability of the drug.

Results: Forty previously healthy patients presenting with acute gastroenteritis were enrolled. The mean age was 4.86±1.37 years. Serum level at 4 h had a median of 26.23 ng/ml, range (8.3–52 ng/ml). Palatability of the drug had a mean of 3.23 (of 5) ± 0.80, based on score from visual analog scale.

Conclusions: Flavored intravenous ondansetron administered orally is a safe and an effective option and can be considered in the absence of the oral forms of the drug.

Prevalence of Overweight and Obesity among Children and Adolescents in Shandong, China: Urban-Rural Disparity


Background: The pattern of urban–rural disparity in childhood obesity varies across countries. The present study examined the change trend of urban–rural disparity in childhood overweight and obesity from 1985 to 2014 in Shandong, China.

Methods: Data for this study were obtained from four cross-sectional surveys of school children carried out in 1985, 1995, 2005 and 2014 in Shandong Province, China. In this study, 39 943 students aged 7–18 years were included (14 458 in 1985, 7198 in 1995, 8568 in 2005 and 9719 in 2014). Height and weight of all subjects were measured; body mass index (BMI) was calculated from their height and weight. The BMI cutoff points recommended by the International Obesity Task Force were used to define overweight and obesity.

Results: The prevalence of overweight and obesity was increasing continuously both in urban and rural areas over the past 29 years (1985–2014). The prevalence of combined overweight and obesity was significantly higher in urban than in rural children and adolescents in 1985, 1995 and 2005 (p < 0.01). However, a rapid increase in the prevalence of combined overweight and obesity was observed in rural areas after 2005; as a result, the urban–rural disparity was getting narrower, and no significant urban–rural disparity was observed in 2014 (p > 0.05).

Conclusion: The change trend of urban–rural disparity should be concerned in the future; policies and interventions focused on childhood overweight and obesity should pay attention to rural areas.

Exclusive Breast-feeding Protects against Mother-to-Child Transmission of HIV-1 through 12 Months of Age in Tanzania


The jury on transmission of HIV through breast-feeding is still on. Data from a clinical trial in children born to HIV-positive mothers were evaluated with respect to their relationship to mother-to-child transmission. A total of 1629 infants who were not infected at age 6 weeks, had HIV results available at 12 months and who were breast-fed were included in this study. Exclusive breast feeding (EBF) rates declined from 85% at 2 months to < 30% by 4 months. EBF was associated with a sustained and significant reduction in HIV infection. With every incremental month of EBF, HIV infection was reduced by 16% [multivariable (risk ratio) RR: 0.84, CI: 0.72–0.98, p = 0.03] from enrollment to 6 months of age and by 18% (multivariable RR: 0.82, CI: 0.72–0.94, p = 0.005) from enrollment to 12 months of age. EBF significantly reduces the risk of vertical HIV transmission through 12 months of age.

The Effect of Rapid Antigen Detection Test on Antibiotic Prescription Decision of Clinicians and Reducing Antibiotic Costs in Children with Acute Pharyngitis


We aimed to investigate the effect of rapid antigen detection test (RADT) in the diagnosis of streptococcal pharyngitis, its impact on antibiotic prescription decision of pediatricians and influence on reduction of antibiotic treatment costs in children with pharyngitis. The study group consisted of 223 patients who were diagnosed with pharyngitis by pediatricians. The sensitivity and specificity of RADT were 92.1% (95% Cl: 78.6–98.3%) and 97.3% (95% Cl: 93.8–99.1%), respectively. In the first assessment, before performing RADT, pediatricians decided to prescribe antibiotics for 178 (79.8%) patients with pharyngitis. After learning RADT results, pediatricians finally decided to prescribe antibiotics for 83 (37.2%) patients with pharyngitis, and antibiotic prescription decreased by 42.6%. Antibiotic costs in non-Group A streptococcus pharyngitis, Group A streptococcus pharyngitis and all subjects groups decreased by 80.8%, 48%, and 76.4%, respectively. Performing RADT in children with pharyngitis has an important impact on treatment decision of clinicians, reduction of unnecessary antibiotic prescriptions and antibiotic costs.

Evaluation of a Portable Haemoglobin Metre Performance in Children with Sickle Cell Disease and Implications for Healthcare in Resource-poor Settings


Background: Sub-Saharan Africa has the largest burden and worst outcome of sickle cell disease (SCD). This gloomy outlook has been attributed to the lack of use of simple and cost-effective measures for diagnosis and treatment of the disease. Although haematology analysers are the gold standard for accurate measurement of haemoglobin (Hb) concentration, they are often out of reach of most health facilities in resource-poor settings, thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyser for determining the Hb concentration in children with SCD and its usefulness in resource-poor settings.

Methods: Ethylenediaminetetraacetic acid blood samples collected from participants were processed to estimate their Hb concentration using two devices (Sysmex KX21N haematology analyser and portable mission Hb device). The agreement between the two sets of measurements was assessed by the Bland and Altman method.

Results: The intraclass and concordance correlation coefficients were 0.854 and 0.936, respectively. Sensitivity and specificity were 84.2% and 98.6%, respectively. The positive and negative predictive values were 94.1% and 96.0%, respectively. The Bland and Altman’s limit of agreement was –2.3 to 1.6 and the mean difference was –0.34 with non-significant variability between the two measurements (p = 0.949).

Conclusion: Hb concentration determined by the portable testing system is comparable with that determined by the haematology analyser. We recommend its use as a point-of-care device for determining Hb concentration of SCD children in resource-poor settings where haematology analysers are not available.

Pulmonary Mycobacterium abscessus Infection in a Patient with Triple A Syndrome


Gastroesophageal disorders such as achalasia can be associated with pulmonary disorders because of non-tuberculous mycobacteria, frequently masquerading as aspiration pneumonia. The optimal therapeutic regimen and duration of treatment for non-tuberculous mycobacteria lung disease is not well established. Here, we present an 11 year old male patient with Mycobacterium abscessus pulmonary disease and underlying triple A syndrome, who was successfully treated with 2 months of imipenem, amikacin, clarithromycin and continued for long-term antibiotic treatment.

Lack of Utility of Nasopharyngeal Swabs for Diagnosis of Burkholderia pseudomallei Pneumonia in Paediatric Patients


Diagnosis of Burkholderia pseudomallei pneumonia in children is challenging. We investigated the utility of nasopharyngeal swabs taken from 194 paediatric patients on admission with radiologically proven pneumonia. Melioidosis was proven in 0.5% of samples tested and only in a third of those known to be bacteraemic with B. pseudomallei. It appears unlikely that culture of nasopharyngeal secretions is helpful to confirm B. pseudomallei pneumonia in paediatric patients.

Necrotizing Periodontal Diseases in Children: A Literature Review and Adjustment of Treatment


Necrotizing ulcerative gingivitis, sometimes observed in young children, may lead to necrotizing stomatitis and noma. Therefore, its interception is a necessity and a challenge for the paediatric practitioners. First, this article aims to propose a systematic review of recent literature on the use of local antiseptic and antibiotic prescription in this particular periodontal condition. Then, a protocol is proposed to have a simple, costless and reproducible treatment on children.

Pendred Syndrome in a Newborn with Neck Swelling: A Case Report


Background: Pendred syndrome is a rare autosomal recessive condition, characterized by functional impairment of thyroid gland and sensorineural hearing loss. The syndrome presents in patients with homozygous or compound heterozygous mutation. The presentation in the form of neck mass in a newborn is rare.

Case characteristics: A 1 month old baby presented to us with neck mass, which was found to be an enlarged thyroid gland. Thyroid function tests were consistent with hypothyroidism. Further evaluation revealed moderate sensorineural hearing loss; genetic analysis showed that baby was homozygous for the known mutations causing the disease.

Intervention: Thyroid hormone replacement and hearing habilitation were done. Follow up showed regression of the neck mass and normalization of thyroid function tests. Genetic counseling of the family was done.

Message: Identification of the exact cause of congenital hypothyroidism can prevent grave consequences later on for the patient as well as for the family.

Plasmodium vivax Malaria Presenting with Multifocal Hemorrhagic Brain Infarcts in a School-going Child


Cerebral malaria is a well-known complication of Plasmodium falciparum malaria. Over recent years, however, Plasmodium vivax also has been reported to cause cerebral malaria with or without co-infection with P. falciparum. Here, we report a boy aged 10 years presenting with acute febrile encephalopathy with raised intracranial pressure to the emergency, who was later diagnosed to have P. vivax malaria. His neurological status improved gradually during 6 weeks of pediatric intensive care unit stay. We report this case to highlight the unusual radiologic findings in the patient, such as multifocal hemorrhagic infarcts in the brainstem, bilateral thalami, frontal cortex and basal ganglia, which have not been reported with P. vivax malaria.