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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 62/4

2016-08-25T07:39:47-07:00







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

2016-08-25T07:39:47-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

 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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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

2016-08-25T07:39:48-07:00

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.




In this issue 62/3

2016-06-17T23:11:33-07:00







Evaluation of Nutritional Status in Children during Predialysis, or Treated By Peritoneal Dialysis or Hemodialysis

2016-06-17T23:11:33-07:00

Objective: Malnutrition is one of the major causes of morbidity and mortality in children with chronic kidney disease (CKD). The objective of this study was to evaluate nutritional status of children with stage 3-4 CKD and treated by peritoneal dialysis or hemodialysis using anthropometric measurements, biochemical parameters and bioelectrical impedance analysis.

Patients and Methods: The study included a total of 52 patients and 46 healthy children.

Results: In anthropometric evaluation, the children with CKD had lower values for standard deviation score for weight, height, body mass index, skinfold thickness and mid-arm circumference than those of healthy children (p < 0.05). The fat mass (%) and the body cell mass (%) measurements performed by bioelectrical impedance analysis were lower compared with the control group (p < 0.05).

Conclusion: It is considered that bioelectrical impedance analysis measurement should be used with anthropometric measurements, which are easy to perform, to achieve more accurate nutritional evaluation in children.




Selenium Supplementation for Prevention of Late-Onset Sepsis in Very Low Birth Weight Preterm Neonates

2016-06-17T23:11:33-07:00

Background: Neonatal mortality continues to be a significant problem in the Indian setting, especially in very low birth weight (VLBW) neonates. Selenium (Se) has been shown to possess antioxidant properties, and some recent studies have shown a reduction in the sepsis-attributable neonatal mortality with its use. India is a Se-deficient country. Blood Se concentrations in newborns are lower than those of their mothers and lower still in preterm infants.

Objective: To evaluate the efficacy of Se in preventing the first episode of late-onset sepsis in VLBW preterm neonates.

Methods: Ninety neonates weighing <1500 g and period of gestation <32 weeks, asymptomatic at birth and admitted to the neonatal intensive-care unit (NICU) in the first 12 h of birth with no maternal risk factors for sepsis were analyzed in the study. Se or placebo was supplemented orally once daily from 1st to 28th day of life to the test (n = 45) or control (n = 45) groups, respectively, followed by daily clinical assessment for signs or symptoms of sepsis in the hospital and weekly after discharge.

Results: Preterm VLBW neonates (mean birth weight 1464.22 ± 50.14 g and mean gestational age 221.75 ± 4 days) are Se deficient at birth, with mean (SD) Se levels 31.1 ± 14.8 µg/l. Se supplementation at 10 µg/day increased serum Se levels significantly (63.9 ± 13.9 µg/l on Day 28 in Se vs. 40.9 ± 17.3 on Day 28 in placebo; p < 0.01). The incidence of the first episode of culture-proven late-onset sepsis was significantly lower in the Se than in the placebo group. [0/45 (0%) in Se vs. 6/45 (13.3%) in placebo; p = 0.033]. The incidence of probable sepsis was found to be significantly lower in the Se group [7/45 (15.55%)] than in the placebo [16/45 (35.55%)]; p = 0.02. The total incidence of any late-onset sepsis (i.e. culture-proven plus probable sepsis) was also significantly reduced by Se supplementation. [7/45 (15.55%) in Se vs. 22/45 (48.88%) in placebo; p = 0.001].

Conclusion: Preterm VLBW neonates are Se deficient at birth. Se supplementation at 10 µg/day resulted in getting the Se levels into the acceptable normal level and reduced the incidence of the first episode of late-onset sepsis in these neonates.




Scrub Typhus: A Clinico-Laboratory Differentiation of Children with and without Meningitis

2016-06-17T23:11:33-07:00

Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. We report the clinical and laboratory profile of 96 children with scrub typhus and compared those with and without meningitis. Twenty seven (28%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), meningeal signs (66.6%), nausea and vomiting (56.3%), seizures (55.5%) and altered sensorium (51.8%). The children with meningitis presented early and had significantly lower respiratory and renal impairments when compared with the non-meningitis group. Cerebrospinal fluid (CSF) analysis revealed elevated total leukocyte count (86.73 ± 94.50 cells/mm3), mononuclear pleocytosis (lymphocyte percentage of 76.85 ± 15.86), elevated proteins (108.33 ± 52.63 mg%) and normal CSF glucose (64.18 ± 15.92 mg%). We conclude that meningitis is a common and early complication of childhood scrub typhus. The CSF reveals a lymphocytic pleocytosis, raised proteins and a normal glucose level. These children respond promptly to appropriate antibiotics as do children without meningitis.




Outcome of Severe Dengue Viral Infection-caused Acute Liver Failure in Thai Children

2016-06-17T23:11:33-07:00

To determine clinical course and outcomes of liver functions in children with dengue viral infection-caused acute liver failure (ALF), the records of patients aged <15 years attending our institution during 1989–2011 were reviewed. Of the 41 ALF patients, 2, 6 and 33 patients had dengue hemorrhagic fever grade II, III and IV, respectively. Multiorgan failure including respiratory failure, massive bleeding and acute kidney injury occurred in 80.0%, 96.0% and 84.0% of the ALF cases, respectively, with an overall fatality rate of 68.3%. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were highest on the day that the patient developed ALF. Lactate dehydrogenase levels had positive correlations with AST (r = 0.95) and ALT (r = 0.87) (all p < 0.01). The median (interquartile range) days before the AST and ALT levels returned to lower than 200 U/L after the ALF were 10.5 (8.8, 12.8) and 10.5 (7.8, 14.0) days, respectively.




Clinical Manifestations of Hyponatremia and Hypernatremia in Under-Five Diarrheal Children in a Diarrhea Hospital

2016-06-17T23:11:33-07:00

Objective: To study clinical manifestations and outcome of hyponatremia and hypernatremia in children with diarrhea.

Method: We compared children aged 0–59 months hospitalized from 1 January to 31 December 2013 with hyponatremia (serum sodium <130 mmol/l), hypernatremia (serum sodium >150 mmol/l) and normonatremia (serum sodium 135–145 mmol/l).

Results: The case fatality was significantly higher among the children with hypernatremia and hyponatremia than normonatremia. A logistic regression analysis adjusting for potential confounders revealed that children with hyponatremia are more likely to have convulsions, have severe acute malnutrition and be of older age compared with children with normal serum sodium. Children with hypernatremia are more likely to have convulsions and dehydration than normonatremic children (for all p < 0.05).

Conclusion: Early diagnosis and prompt management of hypo- and hypernatremia by identifying simple clinical predicting factors of these two conditions in diarrheal children <5 years of age is critically important to prevent deaths in such children, especially in resource-limited settings.




Neonatal Mortality and Morbidity in Regional Provincial Hospitals in the Peoples Democratic Republic of Laos

2016-06-17T23:11:33-07:00

Objective: The aim of this study was to identify the causes and incidences of neonatal diseases and deaths in five provincial hospitals in People's Democratic Republic of Laos retrospectively for the years 2010–12.

Methods: Data of neonatal patients were collected before a 3-year-training program for medical and nursing staff involved in the care of newborn infants in the provincial and associated district hospitals.

Results: In the years 2010–12, a total of 1673 neonatal patients were treated in the provincial hospitals. The reasons of treatment were as follows: 48% infections, 17% complications of prematurity, 14% intrapartum-related complications and 9% other, not categorized diseases. The average mortality rate in all hospitals was 6.5%. The main causes of death were complications because of prematurity, infectious diseases and asphyxia.

Conclusion: These data could be the basis for any teaching program aimed at reducing neonatal mortality. Furthermore, they enable an evaluation of the ongoing teaching program.




Seroprevalence of CMV, HSV-2 and HBV among HIV-Infected Malawian Children: A Cross-sectional Survey

2016-06-17T23:11:33-07:00

Background: Little is known about viral co-infections in African human immunodeficiency virus (HIV)-infected children. We examined the prevalence of seromarkers for cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2) and hepatitis B virus (HBV) infections among HIV-infected, antiretroviral treatment (ART)-naïve children in Lilongwe, Malawi.

Methods: Ninety-one serum samples were tested for IgG and IgM antibodies to CMV, and IgG antibodies to HSV-2 and hepatitis B surface antigen (HBsAg). Baseline demographic, clinical and laboratory data were abstracted from electronic records.

Results: CMV IgG was the most common positive result in all age groups (in 73% of children <1 year, and 100% in all other groups). Three patients were CMV IgM positive (3.3%), suggesting acute infection. HSV-2 IgG was positive in four patients (4.4%), and HBsAg in two (2.2%).

Conclusions: CMV infection occurred early in life, and few children had specific signs of CMV infection at the time of ART initiation. Unrecognized HBV infection represents opportunities for testing and treatment of HIV/HBV co-infected children.




Prevalence and Determinants of Child Maltreatment among School-Going Adolescent Girls in a Semi-Urban Area of Delhi, India

2016-06-17T23:11:33-07:00

The study examines family characteristics that put adolescent girls at increased risk of abuse, mainly physical, sexual and emotional abuse and neglect. Stratified random sampling was done among classes 7th to 12th of government girls' schools of a semi-urban area of Delhi, and a total of 1060 adolescent girls participated. Majority were in mid-adolescence. Approximately 70% study subjects faced at least one form of maltreatment. Physical abuse was faced by 42.6%, sexual abuse by 26.6%, emotional abuse by 37.9% and neglect by 40.1% of study subjects. The most frequent perpetrator of physical and emotional abuse was mother, and of sexual abuse were friends, relatives or neighbours. No or low education of father increased odds of physical and emotional abuse, while odds of physical abuse and neglect were lower if mothers were housewives. Excessive arguments between parents and history of maltreatment in parents increased odds of child maltreatment in study subjects.




Diagnosing Developmental Dysplasia of Hip in Newborns Using Clinical Screen and Ultrasound of Hips--An Indian Experience

2016-06-17T23:11:33-07:00

Aim: To study the cost-effectiveness of clinical screen with ultrasonography (USG) of hip for diagnosing developmental dysplasia of the hip (DDH) in newborns.

Methods: Retrospective study (2006–14). Term newborns had (i) target scan at 6 weeks—family history of DDH or breech presentation—and (ii) early scan—abnormal clinical screen.

Results: In all, 736 babies had USG scan. Five early scans (Graf’s classification; three Type IIA, one Type IIC and one Type IIIB] and 15 target scans (Type IIA) were reported abnormal. All Type IIA DDH had subsequent 12 weeks' scans normal. Babies with Type IIIB and IIC had hip reduction surgery at 6 and 16 months of age, respectively. At cost 200 INR/scan, total 147 200 INR was incurred against two possible hip replacements prevented.

Conclusion: Universal clinical screen with USG of hip can aid in early diagnosis of DDH in newborns. Large population-based studies from developing countries need to look in its cost-effectiveness.




Effects of Kangaroo Care on Neonatal Pain in South Korea

2016-06-17T23:11:33-07:00

Blood sampling for a newborn screening test is necessary for all neonates in South Korea. During the heel stick, an appropriate intervention should be implemented to reduce neonatal pain. This study was conducted to identify the effectiveness of kangaroo care (KC), skin contact with the mother, on pain relief during the neonatal heel stick. Twenty-six neonates undergoing KC and 30 control neonates at a university hospital participated in this study. Physiological responses of neonates, including heart rate, oxygen saturation, duration of crying and Premature Infant Pain Profile (PIPP) scores were measured and compared before, during and 1 min and 2 min after heel sticks. The heart rate of KC neonates was lower at both 1 and 2 min after sampling than those of the control group. Also, PIPP scores of KC neonates were significantly lower both during and after sampling. The duration of crying for KC neonates was around 10% of the duration of the control group. In conclusion, KC might be an effective intervention in a full-term nursery for neonatal pain management.




Fatal Varicella Myocarditis in a Child with Down Syndrome--A Case Report

2016-06-17T23:11:33-07:00

A 12-year-old male child with Down syndrome, who had recovered from congenital heart disease, succumbed to severe varicella myocarditis. His clinical presentation at admission mimicked acute coronary syndrome. Analysis of this case throws insight into several aspects of varicella myocarditis.




Hepatic Abscesses in Preterm Infants: Report of Three Cases and Review of the Literature

2016-06-17T23:11:33-07:00

Purpose: Hepatic abscess is a rare but potentially fatal entity in neonates. The aim of this study was to provide valuable data for diagnosis, management and prevention of hepatic abscess in preterm infants.

Methods: A retrospective chart review was made for patients diagnosed with hepatic abscesses between 2012 and 2015. Methods included clinical and radiological review of records and evaluation of potential risk factors.

Results: A total of three infants with hepatic abscesses were identified. All of them had low birth weight and low gestational age. Predisposing factors included prematurity, late sepsis, umbilical catheterization, necrotizing enterocolitis and previous antibiotic therapy. Isolated organisms from blood included Staphylococcus spp. in two cases and Pseudomonas spp. in one case. To the best of our knowledge, this is the first preterm case of hepatic abscess caused by Pseudomonas aeruginosa in the literature. All patients responded well to antibiotic therapy alone, and no interventional drainage was required.

Conclusion: We suggest evaluating all preterm neonates who have severe sepsis and/or necrotizing enterocolitis signs and who do not respond to prolonged antibiotic therapy with detailed abdominal ultrasound for possible hepatic abscesses as early diagnosis, and treatment favors prognosis.




In this Issue 62/2

2016-03-30T07:00:44-07:00







Epidemiological and Clinical Characteristics of Kawasaki Disease and Factors Associated with Coronary Artery Abnormalities in East China: Nine Years Experience

2016-03-30T07:00:44-07:00

Background: Because of the different genetic backgrounds, living environments and economic conditions, the epidemiologic, clinical characteristics and risk factors for coronary artery abnormalities (CAAs) in the Chinese population may differ among different parts of China.

Methods: We did a retrospective study to explore the clinical characteristics and risk factors for CAAs in east China between 2006 and 2014.

Results: There were 1016 patients during the study period. Of the 1004 patients who completed echocardiographic studies, 23.9% had CAAs. Sex, serum albumin, erythrocyte sedimentation rate (ESR), Mycoplasma pneumoniae (MP) infection, intravenous immunoglobulin (IVIG) started after the 10th day of illness and IVIG non-responders were independent risk factors associated with CAA.

Conclusions: East China has a lower incidence of CAAs compared with southwest and northeast China, while similar to north China. Male gender, serum albumin, ESR, MP infection, IVIG started after the 10th day of illness and IVIG non-responders were predictive of CAA.




Seizures in a Pediatric Intensive Care Unit: A Prospective Study

2016-03-30T07:00:44-07:00

Background: The aim of the research is to determine the etiology and clinical features of seizures in critically ill children admitted to a pediatric intensive care unit (PICU).

Methods: A total of 203 children were admitted from June 2013 to November 2013; 45 patients were eligible. Age ranged from 2 months to 19 years. Seizures were organized as epileptic or acute symptomatic. Pediatric risk of mortality score III, Glasgow coma scale, risk factors, coexistent diagnosis, medications administered before admission, type and duration of seizures, drugs used, requirement and duration of mechanical ventilation, length of stay and neuroimaging findings were collected as demographic data prospectively.

Results: The male–female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were acute symptomatic. Most frequent coexistent diagnosis was infectious diseases, and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalized in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first-line therapy in 48.9%. Acute symptomatic seizures were usually new-onset, and duration was shorter. Epileptic seizures tended to be recurrent and were likely to progress to status epilepticus. However, type of seizures did not change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay were not significant between epileptic/acute symptomatic patients.

Conclusion: Seizures in critically ill children, which may evolve into status epilepticus, is an important condition that requires attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures.




Effect of Sucrose Analgesia, for Repeated Painful Procedures, on Short-term Neurobehavioral Outcome of Preterm Neonates: A Randomized Controlled Trial

2016-03-30T07:00:44-07:00

Background: Safety of oral sucrose, commonly used procedural analgesic in neonates, is questioned.

Aim: To evaluate the effect of sucrose analgesia, for repeated painful procedures, on short-term neurobehavioral outcome of preterm neonates.

Methods: Stable preterm neonates were randomized to receive either sucrose or distilled water orally, for every potentially painful procedure during the first 7 days after enrollment. Neurodevelopmental status at 40 weeks postconceptional age (PCA) measured using the domains of Neurobehavioral Assessment of Preterm Infants scale.

Results: A total of 93 newborns were analyzed. The baseline characteristics of the groups were comparable. No statistically significant difference was observed in the assessment at 40 weeks PCA, among the groups. Use of sucrose analgesia, for repeated painful procedures on newborns, does not lead to any significant difference in the short-term neurobehavioral outcome.




Severe Childhood Anaemia and Blood Transfusion in a Nigerian Secondary Level Facility

2016-03-30T07:00:44-07:00

This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume <20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria.




Anemia Screening and Treatment Outcomes of Children in a Low-resource Community in the Dominican Republic

2016-03-30T07:00:44-07:00

Iron is often initiated for children with low hemoglobin values in the absence of other indicators of iron deficiency in low-resource settings. Unfortunately, there are few reports describing outcomes from such an approach outside of clinical trials. This study examined outcomes of an anemia screening and treatment service in a low-resource community in the Dominican Republic. Complete blood counts (CBC) and receipt of iron supplementation were extracted from health records of young children participating in a well-baby clinic in the targeted community. Of the 265 children screened, 68.7% had hemoglobin values <11.0 g/dl; 61.5% of these anemic children had follow-up CBCs. While 72.3% of those with follow-up CBCs picked-up some iron supplements, only 21.4% had a follow-up hemoglobin ≥11.0 g/dl. Amount of iron given was not related to change in hemoglobin at follow-up. More follow-up monitoring of quality and impact of community care is required with associated evidence-informed benchmark targets.




Prevention and Treatment of Anemia in Infants through Supplementation, Assessing the Effectiveness of Using Iron Once or Twice Weekly

2016-03-30T07:00:44-07:00

Background: The objective of this study was to compare the effect of once weekly iron supplementation (IS) versus twice weekly, on hemoglobin (Hb) levels and anemia prevalence.

Methods: In this cluster-randomized clinical trial study, we evaluated infants aged 6–18 months. Length of intervention: 16 weeks. Infants were cluster randomized to either 25 mgelemental iron once weekly (Group-A) or twice weekly (Group-B). Primary outcome variables were change in Hb concentration and anemia prevalence. Two biochemical evaluations were performed to determine Hb concentrations, before and after intervention.

Results: For Group-A, at baseline, mean Hb concentration was 10.8 ± 1.18 g/dl and after intervention 11.2 ± 1.07 g/dl, p = 0.12; anemia prevalence was 52.5% at baseline and 37.5% after intervention, p = 0.18; Group-B, mean baseline Hb was 10.7 ± 1.04 g/dl, and 11.3 ± 0.91 g/dl after intervention, p = 0.002; anemia prevalence reduced from 57.9 to 36.8%.

Conclusions: Both once and twice weekly IS increased mean Hb concentration; however, twice weekly supplementation provided more significant results.




Treatment Outcomes of Childhood TB in Lagos, Nigeria

2016-03-30T07:00:44-07:00

 Background: Treatment outcomes of tuberculosis (TB) in children are rarely evaluated by most national TB programmes in sub-Saharan Africa. This study evaluated the treatment outcomes of children treated for TB in Lagos State, Nigeria.

Methods: A retrospective review of programme data of the Lagos state TB and the Leprosy control programme in Nigeria from 1 January 2012 to 31 December 2012. Treatment outcomes were categorized according to the national TB guidelines.

Results: A total of 535 cases of childhood TB were notified in 2012, representing 6.3% of the total TB cases notified in Lagos state in 2012. The prevalence of TB/HIV co-infection was 29%. The treatment success rate was 79.2% in TB/HIV-negative children compared with 73.4% in TB/HIV-positive children (p = 0.1268). Children <1 year had the worst treatment outcomes (p < 0.001).

Conclusion: There is a need to intensify effort at improving notification and treatment outcomes in children.




The Clinical Profile of Kawasaki Disease in Algerian Children: A Single Institution Experience

2016-03-30T07:00:44-07:00

Kawasaki disease (KD) in an acute vasculitis of unknown etiology. The epidemiological data available for Algerian patients remains insufficient.

Objective: To describe the demographic, clinical features of children with KD and to identify the risk factors for developing coronary artery lesions (CAL).

Methods: This retrospective study included children admitted with KD at the pediatric hospital in Algiers from January 2005 to December 2014.

Results: One hundred thirty-three patients (82 boys and 51 girls) with a mean age of 31 months were identified. The most common sign was fever, rash, oral changes and conjunctivitis. The cardiac complications were CAL (22.5%), pericarditis (2%) and myocarditis (1.5%). The independent variable for prediction of CAL was duration of fever >10 days, male gender and platelet count >450 000/mm3.

Conclusion: The incidence of cardiovascular complications is high. Knowledge of KD among Algerian pediatricians should be enhanced to guarantee appropriate treatment of this disease.




Postnatal Foot Length to Determine Gestational Age: A Pilot Study

2016-03-30T07:00:44-07:00

Gestational age is a critical factor in the management, decision-making, prognostication and follow-up of newborn infants. It is also essential for research and epidemiology. In the absence of an early assessment of fetal gestation by abdominal ultrasound, many neonatal units in developing countries determine gestational age by neonatal scores and last menstrual period—both of which are highly inaccurate. The aim of this pilot study was to determine whether postnatal foot length measurement could accurately determine gestational age in a specified South African hospitalized neonatal population. Foot length was measured with a plastic Verniere's caliper. Foot length was shown to correlate well with gestational age (r = 0.919, p < 0.001). Intra-observer and inter-observer variability of foot length measurements was low. Foot length can therefore be used with high accuracy to determine the gestational age in a population where there is poor access to or utilization of antenatal sonar.




Genetic Diversity among Group A Streptococcus Isolated from Throats of Healthy and Symptomatic Children

2016-03-30T07:00:44-07:00

Background: Group A streptococcus (GAS) is the commonest bacterial cause of pharyngitis. Children in the age group of 5–15 years are most commonly affected. It can also colonize throats of healthy children in this age group. Both cases and carriers can transmit it in the community.

Methods: Throat swab samples were collected from 1849 asymptomatic and 371 symptomatic children.

Results: The rate of isolation of GAS was 1.41% among the asymptomatic group and 7.55% among the symptomatic group. Nine different emm types were encountered in the asymptomatic children and 14 among the symptomatic children.

Conclusion: Throat swab cultures must be used in all cases of pharyngitis. Early and appropriate antibiotic therapy will prevent complications. Asymptomatic throat carriage of GAS in children was low in our study. However, they can still act as reservoirs. Emm typing helps in understanding epidemiology and finding new types.




Congenital Adrenal Hyperplasia with Non-functional Mutations in Both Alleles in a Clinically Unaffected Infant

2016-03-30T07:00:44-07:00

Background: Results in neonatal screening programs aiming at detection of congenital adrenal hyperplasia (CAH) can only report elevated levels of 17-hydroxy-progesterone (17-OHP), without being able to differentiate presence or absence of salt loss.

Aim: To predict presence or absence of salt loss in newborn infants with CAH.

Methods: The first specimen of suspected CAH in samples sent from People's Democratic Republic of Laos (Lao PDR) was investigated for known mutations in CAH associated with salt loss.

Results: Molecular genetic diagnosis revealed mutations associated with loss of function in both alleles; however, the infant was clinically unaffected even without any corticosteroid substitution therapy.

Conclusions: Although molecular genetic methods can theoretically predict loss of function in CAH, our infant was clinically unaffected even without therapy at 6 years of age. We speculate that in CAH, remaining enzyme activity can be sufficiently high, despite the presence of loss of function mutations, which do not affect infants clinically.




Impacted Sharp Oesophageal Foreign Bodies--A Novel Technique of Removal with the Paediatric Bronchoscope

2016-03-30T07:00:44-07:00

Sharp foreign bodies in the oesophagus may present as an entirely asymptomatic child with only radiological evidence but require emergent surgical management. Safety pins, razor blades and needles are a few of the commonly ingested sharp objects in developing countries. The open safety pin is a particularly interesting clinical problem, as the management depends on its location and orientation. Many methods and instruments have been used over the years to remove them from the upper digestive tract. We present a novel method using the rigid paediatric bronchoscope and alligator forceps for the extraction of this unusual foreign body from the oesophagus of a 6 year old girl.




Nasal HFOV with Binasal Cannula Appears Effective and Feasible in ELBW Newborns

2016-03-30T07:00:44-07:00

Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation.







Malaria Parasite Density Estimation using Actual and Assumed White Blood Cells Count in Children in Eastern Sudan

2016-03-30T07:00:44-07:00

Background: Estimating malaria parasite count is needed for estimating the severity of the disease and during the follow-up.

Objective: This study was conducted to determine the malaria parasite density among children using actual white blood cell (WBC) and the assumed WBC counts (8.0 x 109/l).

Methods: A cross-sectional study was conducted at New Halfa Hospital, Sudan. WBC count and count of asexual malaria parasite were performed on blood films.

Results: One hundred and three children were enrolled. The mean (SD) WBCs was 6.2 (2.9) cells x 109/l. The geometric mean (SD) of the parasite count using the assumed WBCs (8.0 x 109/l cells/μl) was significantly higher than that estimated using the actual WBC count [7345.76 (31 038.56) vs. 5965 (28 061.57) rings/μl, p = 0.042].

Conclusion: Malaria parasitemia based on assumed (8.0 x 109/) WBCs is higher than parasitemia based on actual WBCs.