Journal of Tropical Pediatrics最新文献

Failure to thrive (FTT) is a commonly used term in pediatric clinical practice, referring to a significant deviation from normal growth patterns. It can have multiple adverse effects on a child, including developmental delays, intellectual deficits, and insecure attachment. Inadequate nutritional intake is the most frequent underlying cause. This study aims to identify the risk factors contributing to FTT in infants in a rural North Indian setting. A case-control study was conducted on infants aged 2-12 months admitted to the pediatric ward of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. Detailed histories, clinical examinations, and relevant laboratory investigations were performed for all enrolled patients. Among the 456 study participants, 152 infants (33.33%) were diagnosed with FTT. The majority of cases (92.1%) were from rural areas. Multivariate regression analysis identified key independent risk factors for FTT, including rural residence, incomplete or lack of immunization, absence of exclusive breastfeeding, and lack of timely complementary feeding. This study underscores the significant role of rural residency, inadequate immunization, absence of exclusive breastfeeding, and delayed complementary feeding in increasing the risk of FTT among infants aged 2-12 months in rural North India. Early identification of these risk factors, timely diagnosis, and appropriate interventions are crucial for improving child health outcomes. It will also help in the efficient allocation of healthcare resources.

Paediatric septic shock is a life-threatening condition with high global morbidity and mortality rates. Prior guidelines for paediatric septic shock demonstrated varying levels of effectiveness. In 2017, the institutional paediatric septic shock guidelines were established, emphasizing three pivotal components: prompt recognition, early and appropriate resuscitation, and organ support with intensive stabilization. Herein, we aimed to assess the effect of paediatric septic shock guidelines on mortality and clinical outcomes. This single-centre retrospective cohort study investigating the pre- and postimplementation of paediatric septic shock guidelines was conducted in patients aged 1 month to 15 years diagnosed with septic shock from January 2014 to December 2022. The effectiveness of the guideline implementation was evaluated through propensity matching analysis to compare 30-day in-hospital mortality rates. Adherence to key components of the guidelines was also assessed. In total, 71 and 106 paediatric patients with septic shock were admitted to the paediatric intensive care unit during the pre- and postguideline periods, respectively. The postguideline group exhibited a significant reduction in mortality [adjusted odds ratio (aOR): 0.29, 95% confidence interval (CI): 0.12-0.71, P = .007] and a decrease in respiratory dysfunction (aOR: 0.40, 95% CI: 0.18-0.91, P = .03). Guideline adherence revealed a substantial increase in the use of peripheral inotropes and noninvasive cardiac monitoring. The number needed to treat for the protocol to prevent death was six. The implementation of the paediatric septic shock guidelines, emphasizing early shock recognition, prompt resuscitation, infection control, and appropriate organ management in intensive care, significantly improved outcomes.

Red blood cell (RBC) transfusion is crucial in treating anemia in the pediatric intensive care unit (PICU), though safety and necessity concerns persist. This prospective observational study examined the frequency and predictors of RBC transfusions among critically ill children, highlighting implications for low- and middle-income countries (LMICs). A single-center observational study enrolled 104 children admitted to a PICU from January to September 2021. Demographic details, past medical history, Pediatric Index of Mortality-3 scores, sedation, inotrope administration, ventilator-associated pneumonia (VAP), new-onset shock, respiratory failure, sepsis, renal failure, new or progressive multiple organ dysfunction syndrome (MODS), and duration of ventilation were recorded. Our results showed that 37 patients (35.6%) received RBC transfusions. The mean pre-transfusion hemoglobin level was 6.58 grams per deciliter (g/dl) (SD 1.71). The transfused group required more sedation (P < .001) and vasoactive agents (P < .001), had longer PICU stays (P = .013), and developed VAP (P = .037), new-onset shock (P = .025), respiratory failure (P = .021), and MODS (P = .023) more often than the non-transfused group. Logistic regression analysis showed that hemoglobin >10 g/dl at admission reduced the odds of RBC transfusion [odds ratio (OR) = 0.57, confidence interval (CI) = 0.43-0.74], while sepsis at admission increased the odds (OR = 3.24, CI = 1.09-9.60). The current study demonstrates that about one-third of critically ill children received RBC transfusions. Hemoglobin above 10 g/dl at admission was associated with significantly lower odds of RBC transfusion, while sepsis at admission significantly increased the odds. These findings are particularly relevant for LMICs, where resource constraints necessitate careful evaluation of transfusion practices to optimize patient outcomes and resource utilization.

Serological studies in infants can provide valuable information on the degree of protection conferred by IgG maternal passive transfer during early life. If infant levels are inadequate, protection may be incomplete, increasing the risk of life-threatening diseases such as pertussis and measles, before immunization completion. In addition, HIV infection, -highly prevalent in African countries like Malawi-may impair transplacental antibody transfer. We determined anti-Pertussis Toxin (PT) and anti-measles IgG in 86 6-week-old infants, born to mothers living with HIV (HIV-exposed uninfected, HEU, n = 58) and to HIV-negative mothers (HIV-unexposed uninfected, HUU, n = 28). The HEU group was divided into two subgroups: Infants born to mothers who initiated antiretroviral therapy (ART) during pregnancy (Short-ART, SA-HEU group, n = 29) or already in stable ART (Long-term ART, LA-HEU group, n = 29). The mean anti-PT and anti-measles IgG levels (1.97 IU/ml and 32.9 mIU/ml, respectively) were comparable between the HUU and HEU infants. Overall, only 12.8% and 18.6% of all infants had IgG levels above the protective thresholds for pertussis and measles, respectively. The duration of ART significantly influenced the infant's serological profile, with SA-HEU infants showing significantly lower IgG levels compared to both HUU and LA-HEU infants. Protecting infants during early life remains a significant health challenge in many middle and low-income countries. Achieving better early serological protection requires the implementation of diverse vaccination strategies. This study emphasizes the crucial importance for women living with HIV to be on stable ART before pregnancy.

This study aims to evaluate the efficacy of minimally invasive surfactant therapy (MIST) combined with nasal intermittent positive pressure ventilation (NIPPV) in treating neonatal respiratory distress syndrome (NRDS). The intubation-surfactant-extubation (INSURE) + NIPPV group [receiving INSURE combined with NIPPV] and NIPPV + MIST group (receiving NIPPV combined with MIST) were established. Total administration time, duration of noninvasive ventilation, rate of invasive ventilation after noninvasive ventilation failure, pulmonary surfactant (PS) dosage, length of hospital stay, re-administration of PS, blood gas parameters, serological markers, and complication incidence were assessed between both groups. The NIPPV + MIST group demonstrated a shorter total administration time, lower rate of invasive ventilation support, shorter duration of noninvasive ventilation, reduced hospital stay, and fewer cases requiring re-administration of PS than the INSURE + NIPPV group. After 48 h of treatment, compared to the INSURE  + NIPPV group, the NIPPV + MIST group showed higher arterial partial pressure of oxygen, oxygenation index, and interleukin-4 (IL-4) levels, lower partial pressure of carbon dioxide, fraction of inspired oxygen, interferon-gamma (IFN-γ), and IFN-γ/IL-4 ratio, and lower bronchopulmonary dysplasia incidences, vocal cord injury, and laryngeal edema (all P  < .05). No significant differences were found in PS dosage, oxygen desaturation, bradycardia, nasal injury, air leak, intraventricular hemorrhage ≥ Grade II, or necrotizing enterocolitis (P > .05). MIST combined with NIPPV is effective in treating NRDS by improving ventilation and spontaneous breathing, regulating the Th1/Th2 immune balance, inhibiting pulmonary inflammation, reducing lung injury, and minimizing damage from invasive procedures.

To estimate the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among hospitalized children aged between 1 and 12 years. A cross-sectional study was conducted to determine the seroprevalence of SARS-CoV-2 antibodies among hospitalized children at a tertiary care hospital in the North-East region of India for a period of 13 months (October 2022-November 2023). The presence of SARS-CoV-2 antibodies was estimated using enzyme-linked immunosorbent assay method. Sociodemographic characteristics and clinical profile of the participants were analyzed. The seroprevalence of SARS-CoV-2 infection among hospitalized children aged between 1 and 12 years was estimated to be 98.4%. This was comparable for children between the age groups 1-5 years (97.9%) and 6-12 years (99.1%) (P-value = .478). The most commonly reported symptoms among the seropositive children were fever (76.8%), nasal stuffiness (69.5%), cough (67.8%), diarrhea (23.6%), and nausea/vomiting (23.2%). None of the study participants had a prior history of laboratory confirmed coronavirus disease (COVID-19) infection in the past and none were vaccinated against COVID-19. Results of the univariate analysis showed that there was no significant difference between the seropositive and seronegative children in the distribution of sociodemographic characteristics, clinical profile, and laboratory findings. Our study observed a remarkably high anti-SARS-CoV-2 seropositivity rate of 98.4%, suggesting a significant under-recognized burden of COVID-19 in the pediatric population. The findings highlight the need for continued preventive measures and the development of age-appropriate vaccination strategies, particularly in tropical settings.

The febrile illness caused by dengue is a global public health problem whose incidence is increasing. This infection can range from mild fever to severe illness with plasma leakage and shock; therefore, biomarkers of severity are urgently needed to elucidate the pathological mechanism of the disease. To explore the levels of interleukin (IL)-10 and interferon (IFN)-β in children with dengue to identify these proteins as biomarkers of severity. This study compared the serum levels of IL-10 and IFN-β in 208 Colombian paediatric patients with different degrees of severity of dengue virus infection. A total of three study groups (dengue without warning signs, dengue with warning signs, and severe dengue) were designated according to the World Health Organization classification system. Serotype type 2 was the most prevalent type, and the most frequently reported symptom was vomiting, followed by abdominal pain. Platelet values, aspartate transaminase and alanine transaminase levels and clotting times were the most altered laboratory parameters among the study groups and were more pathological in patients with severe dengue. In addition, IL-10 levels were significantly higher in those with severe dengue than in those with milder forms of infection (P < .05), and IFN-β levels were much lower in the group of patients with severe dengue than in the group with dengue without warning signs (P < .05). These results demonstrate differences in immune responses to dengue infections and suggest several molecular targets for the future development of biomarkers that can serve as diagnostic and prognostic tools for the severity of dengue disease.

The aims of this prospective study were to describe feeding difficulties in term infants with perinatal asphyxia and to determine whether the time it takes to achieve full oral feeding correlates with early neurological outcome in a high-income setting. Recruitment included 52 term infants with perinatal asphyxia: 32 without hypoxic-ischaemic encephalopathy (HIE), 9 with mild HIE, and 11 with moderate HIE. The time in days it takes to achieve full oral independent feeding was used as a marker of feeding difficulty. Early neurological outcome was evaluated using neonatal brain magnetic resonance imaging (MRI) and Hammersmith Infant Neurological Examination (HINE) at 3 months. In this cohort, 85% of infants (44/52) needed short-term assisted feeding after birth. The time it takes to achieve full oral feeding correlated with neonatal brain MRI findings and structured neurological examination results at three months. The time it takes to achieve full oral feeding could be a useful clinical measure to assess neurologic recovery after perinatal asphyxia, especially in low-resource settings.

Pneumonia remains an important cause of morbidity and mortality among children in low- and middle-income countries. Poor outcomes are associated with undernutrition. Nutritional supplementation may be beneficial. We examined the effect of supplementation with lipid-based ready-to-use therapeutic food (RUTF) on the body composition of children with severe pneumonia. Non-severely malnourished children (6-59 months) with severe pneumonia enrolled into the Children's Oxygen Administration Strategies and Nutrition trial in Uganda and Kenya, and randomized to receive a diet supplemented with RUTF (500 Kcal/day) for 56 days versus usual diet alone (control) were included. We assessed arm anthropometry and bioimpedance analysis at admission and days 28, 90, and 180 of follow-up. We used mixed effects linear regression to compare body composition between groups. We included 737 participants (369 in intervention; 368 in control group). The median age was 16 months (IQR; 9, 26), and 58.1% were male. Overall, baseline mean arm fat area (AFA), arm muscle area, and arm muscle circumference were 5.8 ± 1.8 cm2, 11.6 ± 2.3 cm2, and 12.3 ± 1.2 cm2, respectively. The mean fat mass and fat-free mass calculated in 116 participants were 5.5 ± 1.5 kg and 5.5 ± 1.5 kg, respectively. There were modest increases in most body composition parameters. RUTF significantly increased AFA at days 28 and 90 but not at day 180 (P-value = .03, .02, and .99, respectively). RUTF did not change other body composition parameters. Despite initial increases in AFA, RUTF did not change the body composition of children with severe pneumonia.

Emergence of multidrug-resistant strain of Klebsiella pneumoniae has led to limited number of antimicrobial options for treatment. Even though outbreaks of colistin-carbapenem-resistant K. pneumoniae (CCRKp) are evolving, reported literature is scarce. This is a retrospective case series of three infants who acquired CCRKp sepsis during an outbreak in a Level III neonatal intensive care unit (NICU) of a tertiary care centre in Northern India. Data were retrieved from medical records of patients. Three babies developed new onset clinical worsening during an outbreak of sepsis. All had respiratory comorbidities and previous antibiotic exposure prior to isolation of CCRKp sepsis from blood. The organism was sensitive to combination of ceftazidime plus avibactam and tetracyclines in two infants; in one other newborn, no sensitive antibiotic was found. Two neonates deceased due to multiorgan dysfunction. An outbreak investigation revealed one common source of sterile water used in a humidifier. The outbreak was resolved by temporarily closing the NICU, segregating the infected infants and using corrective measures such as procuring a fresh batch of sterile water bottles, disinfecting the NICU, and reinforcing the use of antiseptic techniques. The emergence of CCRKp is alarming, particularly in low- and middle-income countries and tropical regions where such outbreaks are difficult to control due to limited healthcare infrastructure. These findings highlight the urgent need for stringent antimicrobial stewardship practices, enhanced infection control, and tailored interventions in resource-limited settings. It is also to be emphasized that the main mechanism of carbapenem resistance in Kp organisms in Asia seems to be different from the West and is mainly mediated by metallo-beta-lactamases and Class D carbapenemases.