Journal of paediatrics and child health最新文献

Objective: Sepsis is a major cause of mortality among children, with the highest burden evident in neonates and young infants, particularly, in resource-constrained healthcare settings. Despite this burden, there are insufficient published data to delineate the epidemiology of neonatal sepsis from many of these settings. We aimed to address this research gap by evaluating the epidemiology of sepsis in neonates and young infants in Sri Lanka, a populous country in Southeast Asia, and to evaluate the efficacy of currently-recommended empiric antibiotic regimens to treat these infections in the context of evolving antimicrobial resistance.

Design: We evaluated the pathogens (including susceptibility profiles) responsible for infections in neonates and young infants over a 7-year period alongside clinical outcomes (2015-2021).

Setting: A 1100 bed urban tertiary hospital in Colombo, Sri Lanka.

Patients: Neonates and young infants (aged 0 to ≤ 180 days).

Main outcome measures: Blood culture-positive pathogen profiles, antibiotic susceptibility against empiric antibiotic regimens and mortality.

Results: We identified 231 neonates and young infants with clinically significant blood cultures incorporating 251 pathogens over the study period, of whom 22 died. Where gestational data were available, most babies with culture-positive sepsis were premature (71%, 65/91), born at a median gestational age of 32 weeks (interquartile range [IQR] 27-38 weeks). Gram-negative bacteria predominated as a cause of culture-positive infections (66%, 166/251), including in 86% of neonates and young infants who died (19/22). There were high rates of non-susceptibility to first- and second-line antibiotics currently recommended to treat neonatal sepsis.

Conclusions: There is a high burden of antibiotic-resistant gram-negative infections in neonates and young infants in Sri Lanka, highlighting an urgent need to prioritise the development of new antimicrobial regimens to treat neonatal infections.

Aim: To compare clinical and imaging features in children with macrolide-susceptible (MSMP) and macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMP) in a real-world clinical setting.

Methods: We retrospectively analysed paediatric M. pneumoniae (MP) cases at Hunan People's Hospital from June to December 2023, utilizing polymerase chain reaction (PCR) to categorize infections into MRMP and MSMP groups based on 23S rRNA mutations. We compared symptoms, laboratory findings, imaging results and treatment outcomes between MRMP and MSMP groups. Additionally, univariate and multivariate logistic regression analyses were performed to identify factors associated with the switch to doxycycline in MRMP patients.

Results: Of 199 children with MP, 151 were categorized as MRMP due to 23S rRNA mutations, while 48 were classified as MSMP. The MRMP group included more preschool- and school-aged children, with more severe symptoms (persistent high fever and extensive lung consolidation). MRMP patients received longer antibiotic courses, with imaging showing segmental or lobar infiltrates. Consequently, treatment was switched from azithromycin to doxycycline in 66.2% of MRMP patients. Multivariate logistic regression analysis revealed that segmental or lobar parenchymal infiltration was independently associated with an increased likelihood of receiving doxycycline (OR = 3.942, p < 0.001).

Conclusion: These real-world data suggest that MRMP may present with more severe clinical manifestations and radiological features than MSMP among hospitalized children during an atypical post-COVID resurgence of MP. Doxycycline could be considered as the second-line therapy for MRMP patients exhibiting severe symptoms or lung consolidation when macrolides fail to achieve clinical improvement.

Objective: This study aims to systematically retrieve observational studies on risk factors for recurrent respiratory tract infection (RRTI) in preschool children globally and perform a meta-analysis to comprehensively evaluate the effect sizes of major risk factors.

Methods: This study systematically searched databases including PubMed, Embase, Wiley Library, China National Knowledge Infrastructure (CNKI), Wanfang and VIP Chinese Journals Database (VIP) for relevant literature from inception to September 2025. The subjects included were preschool children, the outcome was the diagnosis or occurrence of RRTI and the study types were limited to observational studies. Evaluated indicators included household economic status, maternal age at childbirth, duration of breastfeeding (< 6 months), frequent snack intake (> 7 times/week), passive smoking, asthma and vitamin A deficiency.

Results: A total of 12 studies involving 170 915 children were included. Meta-analysis showed that asthma (OR = 3.26, 95% CI: 1.85-5.7), passive smoking (OR = 1.50, 95% CI: 1.20-1.87) and frequent snack intake (OR = 1.61, 95% CI: 1.35-1.92) were significant risk factors for RRTI in preschool children. Higher maternal age at childbirth (OR = 0.941, 95% CI: 0.913-0.97) showed a protective association. However, no statistically significant associations were found for household economic status (OR = 0.95, 95% CI: 0.82-1.10), breastfeeding for less than 6 months (OR = 1.24, 95% CI: 0.96-1.61) or vitamin A deficiency (OR = 1.42, 95% CI: 0.85-2.36). Sensitivity analyses indicated robust results for the main findings but publication bias could not be assessed due to the limited number of studies included in each meta-analysis.

Conclusion: The occurrence of RRTI in preschool children is influenced by multiple factors. This study confirms that asthma, passive smoking and an unhealthy diet (frequent snack intake) are established risk factors, whilst older maternal age may be protective. For household economic status, breastfeeding duration and vitamin A levels, the current pooled evidence did not establish statistically significant associations with RRTI. Prevention strategies could therefore prioritise asthma management, avoidance of tobacco smoke and promotion of healthy eating to reduce the risk of RRTI.