Journal of paediatrics and child health最新文献

Introduction: STORCH refers to a group of congenital infections (syphilis, toxoplasmosis, rubella, cytomegalovirus and herpes) that can impact the central nervous system. As clinical signs may not appear until several months or years after birth, the early detection of risk in STORCH-exposed infants has been challenging, and the use of sensitive tools in this population is understudied.

Objective: To compare STORCH-exposed infants with non-exposed controls using the Hammersmith Infant Neurological Examination (HINE) at 3 months of age.

Methods: This is an observational cohort study. A total of 60 infants were included and equally allocated into two groups: an exposed group, whose mothers had a clinically confirmed diagnosis of a classic STORCH infection during pregnancy, and a non-exposed control group, whose mothers did not present STORCH infections during gestation. At 3 months of age (13.83 ± 1.09 weeks post-term), infants were assessed using the HINE. Group comparisons were performed for the global score, subscores across the five scorable domains (cranial nerve function, posture, spontaneous movements, tone and reflexes and reactions), number of asymmetries and risk of cerebral palsy.

Results: The exposed group showed lower global scores and lower subscores in most HINE domains compared to controls, along with a higher frequency of asymmetries and an increased proportion of infants classified as at high risk for cerebral palsy.

Conclusion: Infants prenatally exposed to STORCH infections showed an increased risk of impairment based on the HINE when compared to controls. Potential neurological limitations were detectable in the exposed group at 3 months of age.

Aim: Stunting, defined as low height-for-age, impairs growth, cognitive development and contributes to long-term poverty through poor school performance and health outcomes. In Tanzania, 28% of children under 5 are stunted, with Iringa Region showing the highest prevalence (57%). It is unclear why such high incidences occur despite the region being a leading food producer.

Methods: To explore underlying factors, a community-based cross-sectional survey was conducted in four districts of Iringa in September-October 2024, involving children under 2 years. Data were collected using household questionnaires covering feeding practices, water, sanitation and hygiene (WaSH), vaccination, illness and socio-demographic factors.

Results: The median age was 14 months and 205 (51%) were male. Overall, out of 397, 59% were stunted, though most had normal underweight (89%) and wasting status (97.5%). Additionally, 94% met minimum dietary diversity, confirming diet alone does not explain the high stunting rate. Bivariate analysis identified nine significant variables: gender, underweight status, toilet sharing, child hand wash before and after feeding, continued breastfeeding, measles vaccination, vitamin A supplementation and feeding diversity, of which five (5) remained significant in multivariate analysis. Multivariate analysis showed male children had 2.2 times higher odds of stunting; risk also increased among underweight children but was lower in those under 1 year. Continued breastfeeding after 6 months reduced odds of stunting by 61%. Children in households sharing toilets had almost half the odds.

Conclusion: Findings highlight the need to promote breastfeeding beyond 6 months, strengthen nutrition and WaSH programs and target interventions for male and underweight children.

Background: Paediatrics obstructive sleep apnoea syndrome (OSAS) is often underdiagnosed by medical practitioners due to its subtle and nonspecific symptoms in children. This study aimed to determine the prevalence of OSAS and identify clinical predictors of its occurrence and severity.

Methods: Medical records of children (2-18 years) who underwent polysomnography (PSG) at a sleep laboratory in Myanmar during 2012-2023 were reviewed retrospectively. Children with incomplete PSG data, a prior PSG record in the same sleep laboratory, or a history of adenotonsillectomy were excluded from the study.

Results: This study included 349 children with mean ± SD age 6.8 ± 2.8 year. OSAS was identified in 82.2% (289/349). Boys, overweight/obesity and tonsil grade-4 were independently associated with OSAS and boys, overweight/obesity, lower resting SpO₂, witnessed apnoea, abnormal daytime sleepiness and tonsil grade-4 were independently associated with severe OSAS on multivariable logistic regression. Among 2-8-year-old children, there was a significant mild positive correlation between AHI and tonsil grades (r = 0.29, p < 0.001) and between AHI and BMI (r = 0.21, p < 0.001). Among 9-18-year-old children, there is a moderate positive correlation between AHI and BMI (r = 0.34, p = 0.003); however, the correlation between AHI and tonsil grades was not significant r = 0.08 (p = 0.51).

Conclusion: Male sex, overweight/obesity and tonsil grade-4 can predict OSAS and its severity in children. Lower SpO₂ levels, witnessed apnoea and excessive daytime sleepiness can also predict severe OSAS. Although the degree of obesity is correlated with OSAS severity in both older and younger children, the degree of tonsil grades is correlated with its severity only in younger children.

Objective: This randomised controlled trial aimed to evaluate the effect of a multi-strain probiotic on the incidence of common infections among children in early childhood education (ECE) settings.

Methods: Prospective, randomised, double-blind, placebo-controlled trial was conducted using a multi-strain (mixture of 5 strains) probiotic at a daily dose of 10 billion active fluorescent units. Participating children were randomly assigned to either the intervention or control group. The supplementation period lasted 24 weeks, during which weekly questionnaires were administered to track the incidence of infections.

Results: A total of 118 children were enrolled in the trial. An intention-to-treat analysis revealed a 62% reduction in the incidence of gastrointestinal tract infections (GITIs) (incidence rate ratio: 1.62, p = 0.055) between the placebo and probiotic groups in the last 16 weeks of the study. Notably, it took up to 8 weeks for probiotics to exhibit a significant protective effect. However, probiotic supplementation had no impact on respiratory tract infections (RTIs). Additionally, probiotic use led to an estimated cost saving of AU$4748 in relation to reducing GITIs for 16 weeks after the protective effect was achieved.

Conclusion: Multi-strain probiotic has the potential to reduce the risk of GITIs among children in ECE settings, though no beneficial effect was observed on RTIs despite recording over 450 infections. Larger, multi-arm trials are recommended to further investigate this area.

Trial registration: ClinicalTrials.gov identifier: ACTRN12622000153718.

Aim: To evaluate clinical features, management, and outcomes of paediatric bone and joint infection (BJI) in a regional Australian hospital and assess weight-based oral antibiotic prescribing.

Methods: We conducted a retrospective study of 171 children aged 0-18 years admitted with septic arthritis and/or osteomyelitis between 2011 and 2021. Cases were identified using ICD-10-AM codes, and data on clinical presentation, microbiology and treatment were extracted from medical records. Oral antibiotic doses were assessed against international evidence-based guidelines.

Results: A total of 171 children were included (median age 27 months); 59.6% were aged ≤ 5 years, and 13.5% identified as Aboriginal or Torres Strait Islander. Staphylococcus aureus was the most frequently identified pathogen overall (53/108, 49.1%), and Kingella kingae in children < 5 years of age (20/57, 35.1%). Severe disease occurred in 29.8%. Oral antibiotic doses were below international guideline recommendations in 43.3% of cases, mostly with amoxicillin-clavulanate and cephalexin. Relapse (4.1%) and long-term sequelae (6.1%) were infrequent.

Conclusions: Paediatric BJI mostly occurred in young and in Aboriginal and Torres Strait Islander children. Oral antibiotic weight-based dosing was often lower than international guideline recommendations for BJI. These findings highlight the need for standardised antibiotic dosing in BJI and further studies to optimise dosing in children.