Journal of Tropical Pediatrics最新文献

Background: Acute diarrhea remains a major cause of mortality in children under five, with over 40 known enteropathogens. In Vietnam, most studies have focused on individual pathogens or pathogen groups.

Objectives: This study aimed to characterize the etiological profile of children with acute watery and acute bloody diarrhea, describe epidemiological and clinical characteristics across pathogen groups, and examine the characteristics of Rotavirus-infected children.

Methodology: From 10 December 2022 to 30 April 2023, 382 children under five hospitalized with acute diarrhea at the Gastroenterology Department, Children's Hospital 1, Vietnam, were tested for enteric pathogens using multiplex real-time RT-PCR.

Results: Fifteen pathogens, including viruses, bacteria, and parasites, were identified among 382 cases. Group A Rotavirus (55.2%), Adenovirus (20.9%), Norovirus II (13.9%), and diarrheagenic Escherichia coli (DEC) (9.2%) were the most frequently detected pathogens. Coinfections were observed in 39.0% of cases. Vomiting, watery diarrhea, and vomiting at onset were more common in viral infections, whereas bloody stools, high-grade fever, and fever at onset predominated in bacterial infections. Unvaccinated children with Rotavirus infection experienced higher diarrhea frequency and longer durations of diarrhea, vomiting, fever, and hospitalization.

Conclusion: The microorganisms associated with acute diarrhea are diverse, with 15 pathogens identified, Group A Rotavirus, Adenovirus, Norovirus II, and DEC being the top four most common. Clinical features showed differences among pathogen groups. Understanding epidemiological and clinical information may support early clinical decision-making in Vietnam in the absence of diagnostic testing. Further studies are needed to assess their similarity and applicability in low- and middle-income countries.

Feeding intolerance (FI) in preterm infants may signal necrotizing enterocolitis (NEC), in which oxidative stress (OS) plays a central role. Melatonin has demonstrated promise in mitigating neonatal OS-related diseases. The study is aimed to assess the effect of enteral melatonin on the progression of FI symptoms, NEC incidence, and tumor necrosis factor-alpha (TNF-α) levels in preterm neonates with FI, compared with conventional therapy (CT). Ninety preterm neonates with FI were randomly assigned to either the melatonin group (MT, n = 45), who received melatonin plus conventional therapy, or the conventional group (CT, n = 45), who received conventional treatment. Melatonin was administered enterally in two doses of 10 mg each, 1 h apart. TNF-α levels were measured in all patients 72 h posttreatment. CT group experienced extended hospital stay, longer feeding discontinuation, delayed full enteral intake, higher NEC incidence, increased mortality, and higher TNF-α compared with the MT group (P = .032, <.001, <.001, <.001, .03, and <.001, respectively). Enteral melatonin significantly reduced NEC incidence and mortality, accelerated achievement of full enteral feeding, and lowered TNF-α levels in preterm neonates with FI. It demonstrates a practical, affordable, orally administered therapy that is accessible and reproducible in low-resource settings, addressing the burden of NEC in preterm infants where it is critically needed.

It is estimated that 70 million children and adolescents have latent tuberculosis infection (LTBI) worldwide, thus representing an important reservoir of the disease. Diagnosis and prophylaxis of LTBI in this population remain a challenge because of social factors and barriers in contact investigation. The objective of this study was to describe barriers in the follow-up of children and adolescents who are household contacts of adults with pulmonary tuberculosis (PTB). This was a prospective cohort study of children and adolescents, household contacts of PTB, followed for 2 years after contact detection, in the region of Itaboraí, Rio de Janeiro, Brazil. Out of 90 subjects included in the study, aged 0-15 years, 44 were lost to follow-up (48.9%), poverty being the main cause of being lost to follow-up. In the multivariate analysis, losses to follow-up were associated with male gender (P = .01) and with the caregiver's low level of education (P = .001). There was a lower chance of being lost to follow-up when the infection source was a sibling (P = .004). The absence of a guardian to accompany the child to medical consultations was linked to the loss of follow-up (P = .07). The main barriers to the diagnosis and treatment of LTBI in children and adolescents in our study population were socioeconomic and educational factors. Preventive treatment is still a challenge in tuberculosis endemic areas.

Diagnosis of paediatric pulmonary tuberculosis (PTB) continues to be a major challenge due to the inability to expectorate and paucibacillary nature of the disease. In endemic settings, the diagnosis of paediatric PTB depends mainly on clinical and radiological features as gastric aspirate (GA) is an unpleasant procedure and requires expertise as well as hospital admission. This hinders microbiological diagnosis and resistance detection. This study aims to evaluate the use of a less invasive, alternative specimen like stool for the microbiological confirmation of paediatric PTB. Gastric aspirate or induced sputum (IS) and stool samples (at least 2 gm) samples were collected from children of age <14 years old with suspected PTB admitted in the paediatric department. IS/GA was tested as per National Tuberculosis Elimination Programme protocol by Xpert MTB/RIF-Ultra assay. Processing of stool samples was standardized and appropriate protocol followed for Xpert MTB/Rif-Ultra assay. A total of 104 pairs of samples were tested by Xpert-Ultra assay. Eighteen of 104 GA/IS samples were positive; of which stool samples were positive in 15 cases. The bacterial load in 2 samples were low and very low in one. All GA/IS with medium and high bacterial load were detected by Stool Xpert-Ultra assay, and stool Xpert assay was positive in five GA/IS Xpert-Ultra negative samples. Stool can be used as an alternative sample for the diagnosis of paediatric PTB.

Despite well-documented benefits of omega-3 for maternal and child health, evidence on high-docosahexaenoic acid (DHA) supplementation in low-risk pregnant women is limited. A randomized, double-blind, placebo-controlled trial was conducted among low-risk pregnant women aged 20-40 years at 22-24 weeks of gestation to evaluate the effects of high-DHA omega-3 supplementation on maternal and neonatal health outcomes. The control group (CG, n = 30) received oral olive oil supplementation, and the intervention group (IG, n = 30) received omega-3 [1700 mg, 260 mg of eicosapentaenoic acid (EPA), and 1440 mg of DHA] for ∼16 weeks or until delivery. Maternal and neonatal health outcomes were collected by telephone 15 days after delivery. Forty-five pregnant women completed the study (IG: 20; CG: 25). Adherence to supplementation was above 90% and did not differ between groups (P > .05). There were no differences between groups in mean gestational age (CG: 39.3 ± 1.6; IG: 39.2 ± 1.6; P = .877), adequate gestational weight gain (CG: 24.0%; IG: 50.0%; P = .088), adequate gestational BMI before delivery (CG: 33.3%; IG: 27.8%; P = .261), vaginal delivery (CG: 72.0%; IG: 60.0%; P = .396), full-term birth (CG: 92%; IG: 90%; P = .815), adequate weight (CG: 91.3%; IG: 94.7%; P = .237), and adequate length for gestational age (CG: 82.6%; IG: 100%; P = .056). Omega-3 supplementation with a higher concentration of DHA had no effect on the maternal and neonatal health outcomes investigated in a Brazilian sample of low-risk pregnant women. Further studies are needed to evaluate this effect in pregnant women at higher nutritional risk and with low dietary intake of omega-3.

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.