Journal of Tropical Pediatrics最新文献

Home-Based Newborn Care (HBNC) is a Government of India initiative to reduce neonatal mortality. This study assessed coverage of appropriate HBNC services in a community development block in West Bengal, identified subcentres with acceptable coverage, and explored perceptions of beneficiaries and challenges of Accredited Social Health Activists (ASHAs). A mixed-methods, cross-sectional study employing Lot Quality Assurance Sampling (LQAS) was conducted in Barrackpore-II block, North 24 Parganas, West Bengal. A total of 434 mother-child dyads with infants aged 43-60 days were surveyed. Each of the 31 subcentres constituted a lot, with a sample size of 14 and a decision value of 4, based on threshold values of 50% and 85%. HBNC services were deemed 'appropriate' if all home visits adhered to the prescribed schedule (±1 day), i.e., 'complete' and were 'effective'. Essential components of an effective visit included promotion of exclusive breastfeeding, eye and cord care, temperature and weight measurement, and proper hand hygiene. Qualitative data were obtained through 19 in-depth interviews and eight focus group discussions. Nearly half of the lots (48.4%) had unacceptable HBNC coverage, and estimated overall coverage was 67.6%. Key challenges for ASHAs included socio-economic disparities, low perceived credibility, irregular payments, and inadequate co-ordination. Beneficiary perception regarding HBNC was influenced by the fulfilment of expected support from ASHA. Strengthening both demand-factors (community awareness and perceived credibility of services) and supply-factors (capacity building, timely remuneration, and robust inter-sectoral co-ordination) are crucial to improving effectiveness of Home-Based Newborn Care.

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.

Background: Clinical spectrum of children presents with acute liver injury (ALI) is quite wide, ranging from asymptomatic enzyme elevation to severe hepatic dysfunction. This study aimed to evaluate the clinical and etiological profile and outcomes of children 1 month to 12 years presented with ALI at a tertiary care hospital in North India.

Methods: This prospective observational study enrolled 132 children with AL. Detailed clinical evaluation, liver function tests, and etiological workups were performed. The severity of ALI was classified based on liver enzyme levels, and patient's diagnosis and outcomes were assessed.

Results: Among the enrolled children (47.7% female, mean age 69.3 months), fever (85.6%) was the most common presenting symptom. ALI severity was classified as mild (29.5%), moderate (15.1%), and severe (55.3%). The leading cause of ALI was Acute Viral hepatitis (37.1%), followed by Enteric fever (21.9%) and Dengue fever. Non-Hepatotropic viruses such as Influenza, Adenovirus were identified in 11 (8.3%). Infants primarily presented with mild ALI related to viral infections, whereas children aged 1-5 years and >5 years had higher proportions of severe ALI. Follow-up investigations at two weeks showed improvement in 77.1% of patients, while 22.9% had persistent liver enzyme elevation.

Conclusion: Infectious causes, particularly viral hepatitis, remain the predominant etiology of ALI in Indian children. Severe ALI was frequently associated with viral hepatitis, Enteric fever and dengue. In addition, Non-hepatotropic viruses are important cause of ALI. Consideration of these common illnesses is important to avoid unnecessary investigations and parental anxiety.

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.

The pediatric intensive care unit (PICU) at the Academic Hospital Paramaribo (AHP), operational since 2017, is the only tertiary referral center for critically ill children in Suriname. This study aims to describe the clinical and demographic characteristics and outcomes of critically ill children treated in the PICU over 2 years, and to assess risk factors associated with mortality during PICU admission. A retrospective study of admissions from children 16 years and younger admitted to the PICU of the AHP between January 1, 2021, and December 31, 2022. During the study period, 424 PICU admissions were included, of which 91% were acute and unplanned. The most frequent medical reasons for admission were convulsions (8.5%), pneumonia/lung abscess/empyema (7.5%), and bronchiolitis (7.3%). One hundred thirty-six admissions (32.0%) received mechanical ventilation, and 104 (24.5%) required inotropes. The median PICU stay was 3 days (interquartile range 0-6), with a mortality rate of 12.0%. In the multivariate analysis, only male gender, mechanical ventilation, and inotropes were associated with increased risk of death. The results of this benchmarking study can ultimately serve as a valuable resource for policy-makers and important stakeholders in the process of improving the care provided to critically ill children in Suriname.