Journal of Tropical Pediatrics最新文献

Neonatal mortality remains a global health challenge, particularly in sub-Saharan Africa, where infections often caused by multidrug-resistant (MDR) organisms are a leading cause of death. This study aimed to assess the prevalence of MDR ESKAPE pathogens and Candida auris colonization among hospitalized neonates in a non-outbreak setting, identify associated risk factors, and characterize antimicrobial resistance patterns. A cross-sectional sub-study was conducted at a tertiary hospital in South Africa between November and December 2020. A total of 258 rectal and skin swabs were collected from 86 neonates and cultured for ESKAPE organisms and C. auris. Isolated MDR organisms underwent further characterization. Of the 135 ESKAPE + C. auris isolates identified, 70.4% (95/135) were MDR. Colonization with ESBL-producing Klebsiella pneumoniae was most common (65%, 56/86), followed by XDR Acinetobacter baumannii. NDM-producing A. baumannii (5.8%) was more frequently detected than carbapenemase-producing Enterobacterales (3.9%). A prolonged hospital stay (median 14 days, P < .001) was significantly associated with MDR colonization. Rectal and skin swabs provided comparable yields for Gram-negative MDR organisms. The high prevalence of MDR ESKAPE + C. auris colonization highlights the value of routine, non-invasive screening for surveillance in neonatal units. Enhanced infection control strategies and improved surveillance systems incorporating colonization swabs and clinical risk profiling are urgently needed.

To assess the feasibility and effectiveness of administering surfactant via an orogastric feeding tube used as a thin tracheal catheter, compared with the Intubation-Surfactant-Extubation (InSurE) method, in preterm neonates with respiratory distress syndrome (RDS). This was hospital-based, randomized controlled trial. The intervention group (Group A) received surfactant via an orogastric tube with direct laryngoscopy while maintaining continuous positive airway pressure (CPAP) therapy. The control group (Group B) received surfactant using the standard InSurE technique. Data collected included demographic details, feasibility criteria, clinical condition, respiratory support requirements, complications, and final outcomes. Baseline characteristics were comparable between groups. All 120 infants in the intervention group received surfactant via the feeding tube successfully on the first attempt, with uninterrupted administration, no premedication, no conversions to intubation, no procedure-related bradycardia, desaturation, or apnea, and no significant regurgitation. The need for mechanical ventilation was significantly lower in the feeding-tube group compared with InSurE (22 vs. 35; P = .049, relative risk 0.74). The mean duration of oxygen therapy, hospital stay, rates of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) (grade II or higher), air leaks, sepsis, and mortality did not differ significantly between groups. Surfactant administration via an orogastric feeding tube inserted into the trachea is feasible, safe, and as effective as the InSurE method in preterm neonates of 28-34 weeks' gestation. This low-cost, universally available alternative has important implications for improving access to surfactant therapy in resource-limited settings of tropical low- and middle-income countries (LMICs).

Mycobacterium bovis (M. bovis), a member of Mycobacterium tuberculosis complex, can cause tuberculosis in both adults and children. Our study aimed to identify the clinical and laboratory features of children with M. bovis infection. This retrospective descriptive study sampled a cohort of consecutive cases diagnosed as M. bovis infection by culture positivity from October 2013 through May 2023. Epidemiological data were obtained on gender, age, region of residence, clinical signs, exposure, treatment, and outcome. The analysis was performed using descriptive statistics. M. bovis was found to be the causative agent in seven of 25 patients with culture-confirmed tuberculosis, but M. bovis mostly caused extrapulmonary disease, the most frequent clinical form being cervical lymphadenitis. The most common symptoms were fever and neck swelling. No resistance was detected, except to pyrazinamide, in the strains. M. bovis has a significant disease burden in children. Advanced typing is recommended for M. tuberculosis complex culture positivity to determine the appropriate treatment regimen.

Variants in the SLC26A4 gene are the most common cause of hereditary hearing loss in Pakistan, and the second most common cause worldwide. Advances in genetic diagnosis can make it more time-efficient, cost-effective, and accessible to clinicians and patients. The study aimed to screen 260 consanguineous Pakistani families with hereditary hearing loss for the DFNB4/PDS locus and to detect pathogenic SLC26A4 variants across different castes. We used homozygosity mapping to predict pathogenic variants and selected seven SLC26A4 exons for direct sequencing in 19 of the 23 DFNB4/PDS-linked families, based on haplotype comparison. Sequencing data were analyzed using Chromas software (Technelysium Pty. Ltd, version 1.45), and the detected variants were stratified by castes of the enrolled families. Four missense variations (c.269C>T, c.716T>A, c.1337A>G, and c.1667A>G) were identified in 16 families, as predicted by haplotype analysis, in exons 3, 6, 11, and 15 of SLC26A4. The Q446R (c.1337A>G) variant was identified in eight families, all belonging to the Arain caste of Pakistan. Caste data from a previous study of Pakistani patients similarly supported its potential role in caste-based genetic diagnosis. In PKDF497, six double heterozygotes for variants of GJB2 and SLC26A4 were detected without hearing loss. We present evidence supporting caste-based targeted variant screening for hereditary hearing loss. Following additional validation studies, caste-based targeted variant screening for common hereditary disorders could be implemented in developing countries, particularly in South Asia, to provide faster and more cost-effective molecular diagnosis compared to whole-genome or whole-exome sequencing.

The periviable period represents the earliest stage of foetal maturity, where survival outside the womb is possible but uncertain. With no national consensus on periviable care, management depends on family preferences, clinical expertise, and available resources. This study evaluates outcomes of periviable infants in a tertiary-care neonatal unit. To assess mortality, in-hospital morbidities, and neurodevelopmental outcomes in periviable infants across two time periods. This retrospective cohort included infants born between 23 + 0 and 26 + 0 weeks, who received active intensive care and survived beyond 12 hours, from January 2017 to December 2023. Two epochs were defined: 2017-20 (epoch 1) and 2021-23 (epoch 2), to evaluate the impact of evolving perinatal and neonatal practices on outcomes (survival and morbidities). Neurodevelopmental follow-up was performed at 1-2 years corrected age using the Developmental Assessment Scale for Indian Infants (DASII). Data analysis was performed using SPSS. Among 140 infants (71 epoch 1, 69 epoch 2), baseline gestational age and birth weight were comparable. Mortality was 42.3% in epoch 1 vs. 30.4% in epoch 2 (P = .15). Bronchopulmonary dysplasia (BPD) rates were 40% vs. 45% (P = .66). The composite outcome of death/BPD was 67.7% vs. 60.7% (P = .41). Neurodevelopmental delay was seen in 36% vs. 42.9% (P = .77). None of the differences were statistically significant. Periviable infants continue to have high mortality, morbidity, and neurodevelopmental impairment. No significant improvements in survival or BPD rates were observed between epochs.

Injury is the leading cause of death for youth aged 5-24 years with the majority of deaths occurring in low- and middle-income countries (LMICs). Interventions directed at reaching appropriate care faster have the potential to improve pediatric injury-related outcomes in LMICs. Using a pediatric injury registry, we examined the rates of morbidity and mortality of pediatric injury patients in Northern Tanzania based on referral status, location, distance, and time to definitive care. We included 849 patients aged <18 years. Patients treated at a health care facility prior to KCMC had higher morbidity that those who presented direct to KCMC. There was no significant association between distance of first care site to KCMC and mortality or morbidity, however there was a statistically significant increase in mortality with longer time to definitive care at KCMC. We found that pediatric injury patients treated at first care sites prior to KCMC had higher morbidity. Additionally, the chance of mortality was statistically higher in pediatric injury patients who took longer than 48 hours to reach definitive care at KCMC. This study identifies facilities with longer median times and allows for future targeted interventions to improve pediatric readiness and raising awareness of the importance of timely pediatric specific injury care.

To evaluate the association between assisted reproductive techniques (ART) and the risk of attention-deficit hyperactivity disorder (ADHD) in children. A systematic search was done in PubMed, Embase, Web of Science, and Scopus. Cohort and case-control studies were included. Effect sizes were pooled using hazard ratios (HRs) with 95% confidence intervals (CIs), and subgroup analyses were performed by sex, multiplicity of pregnancy, and gestational age. Heterogeneity and publication bias were assessed, and the certainty of evidence was evaluated using GRADE criteria. Children conceived through in vitro fertilization (IVF)/intracytoplasmic sperm injection had a slightly increased risk of ADHD compared to those conceived spontaneously (HR 1.07, 95% CI: 1.04, 1.10), with a moderate certainty of evidence. Three studies on ovulation induction /intrauterine insemination led to a pooled effect size of HR 1.13 (95% CI: 1.04, 1.23) with a moderate certainty of evidence. Subgroup analyses indicated an increased risk in both boys and girls. Singleton pregnancies exhibited a higher risk, while no significant association was observed in multiple pregnancies. Term births showed an elevated risk, with a higher but non-significant effect size in preterm births. Moderate certainty of evidence suggests that the magnitude of observed risk of ADHD is small in ART-conceived children, which is reassuring for parents and clinicians. Long-term monitoring, developmental screening, and tailored counselling for parents of ART-conceived children might be useful.

Background: Familial hypercholesterolemia (FH), which is traditionally viewed as a monogenic disorder, has significant variability in its phenotypic expression, particularly its physical characteristics. Understanding the relationship between genotype and phenotype is essential for the effective diagnosis and management of this condition, especially in pediatric populations. This study aimed to investigate the correlation between genotype and phenotype in Egyptian children diagnosed with FH.

Methods: A consecutive sample of 35 Egyptian children diagnosed with FH was recruited for the study. Phenotypic characteristics were comprehensively analyzed and correlated with genetic variants. Next-generation sequencing was employed to identify pathogenic variants in genes associated with FH.

Results: Among the 35 cases analyzed, 33 (94.3%) were found to have pathogenic variants in the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB), or PCSK9 genes, with variants in LDLR accounting for approximately 90% of these cases. Zygosity analysis indicated that 63.6% of the children had biallelic pathogenic variants, with 42.4% being homozygous and 21.2% compound heterozygous, whereas the remaining 36.4% were heterozygous. The occurrence of xanthomas, early markers of atherosclerosis, abnormal echocardiographic findings, and elevated levels of total cholesterol and low-density lipoprotein cholesterol were significantly more common in children with homozygous FH.

Conclusion: This study revealed a significant correlation between genotype and phenotype in Egyptian children with FH, with homozygous individuals experiencing more severe clinical symptoms. These findings underscore the importance of genetic screening in assessing disease severity and tailoring treatment strategies.

This open-label parallel randomized control trial compared the need for invasive ventilation and continuous positive airway pressure (CPAP) duration in preterm infants receiving CPAP with or without kangaroo mother care (KMC). Preterm neonates from 28 to 36 weeks 6 days with a Downe's score ≥4 to 6 were eligible for CPAP and were recruited at Shree Krishna Hospital, Gujarat. Using balanced randomization, 111 participants were randomly assigned to two groups. KMC was initiated within one hour of CPAP versus in non-KMC group, neonates were placed under servo-controlled warmer with CPAP. The mean [standard deviation (SD) birth weights (1876.91 [456.51] vs. 1909.98 [387.46] grams] and gestational ages [32.5 (2.6) vs. 32.3 (2.8) weeks] were comparable between groups. The mean (SD) KMC hours in the intervention group before weaning from CPAP were 9.57 (7.72) hours. The success rate (without the requirement for invasive mechanical ventilation) was higher in the intervention group (92.6% vs. 75.4%, P = 0.01). Among neonates who were successfully weaned off ventilation, the mean (SD) CPAP hours were lower in the intervention group [23.19 (20.33) vs. 37.66 (24.40), P = 0.003]. The mean (SD) FIO2 [38.37 (13.36) vs. 44.88 (15.73), P = 0.02] and positive end expiratory pressure (PEEP) [6.30 (0.66) vs. 6.72 (0.70), P = 0.01] requirements were lower in the KMC intervention group, the thermoregulation was better, and there was earlier establishment of feeds. Provision of KMC in preterm newborns requiring CPAP at birth leads to reduced duration of CPAP support and CPAP failure.

Clinical trial registration: CTRI/2014/12/005309 [Registered on: 17/12/2014].

Invasive fungal infections, particularly those caused by Trichosporon species, have increasingly been observed in recent years, leading to high morbidity and mortality rates in immunosuppressed patients. Trichosporon asahii is the most common species associated with systemic infections. Despite their clinical importance, especially in pediatric patients, information remains limited. This study aims to investigate the clinical characteristics, comorbidities, treatment methods, and outcomes of invasive Trichosporon infections diagnosed over 10 years at a university hospital. The medical records of patients diagnosed with invasive Trichosporon infections between December 2013 and January 2024 at our center were retrospectively reviewed. A total of 12 cases of invasive Trichosporon infection were examined during the study period. In 75% of these cases, the isolated species was T. asahii. Underlying comorbidities were present in 33.3% of the patients, with hematologic malignancies in 33.3% and immunodeficiency in 33.3%. Among the treatment strategies, 12.5% of the patients received voriconazole monotherapy, and 37.5% received a combination of voriconazole and antifungal therapy, with the most common combination being voriconazole and liposomal L-AmB. The overall mortality rate was 41.7%, with 7-day mortality at 8.3% and 30-day mortality at 25%. Invasive Trichosporon infections are serious infections with a high mortality risk in immunocompromised patients. Early diagnosis, timely initiation of appropriate antifungal therapy, and management of underlying comorbidities are critical for improving patient outcomes. Due to the limited number of cases, further research in this field is needed.