Journal of Tropical Pediatrics最新文献

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.

Neonatal screening has not been demanded by pediatricians nor parents in India because of limited resources, inadequate health information, early hospital discharges, a large rate of deliveries at home, and challenges with follow-up of results. This study was conducted based on the laboratory e-records from the Newborn Screening Unit, where Dried Blood Spot-based analysis was performed for G6PD deficiency, congenital adrenal hyperplasia, neonatal hypothyroidism, biotinidase deficiency, and galactosemia. The total study population comprised 3210 neonates. Overall, 329 children (10.2%) had some form of inherited disorder, and 12 (0.4%) suffered from two disorders concomitantly. The highest number of children were suffering from partial biotinidase deficiency (4.5%), followed by G6PD deficiency (2.7%). There was no significant difference in the levels of measured analytes in males and females, except for 17-OHP, which was significantly higher in males. Compared with females, males were more likely to have G6PD and biotinidase deficiency. Our study provides a snapshot of five inherited disorders previously unexamined by neonatal screening in Eastern India. We found a high prevalence of G6PD deficiency and other substantive neonatal conditions. Now that the significant prevalence of these disorders is known, stakeholders should work with policy-makers to institute national-level screening to determine their distribution in the broader population and address them in affected groups. Further studies are needed to identify effective implementation strategies, overcome financial and logistical barriers to an NBS program, and assess whether such a program can reach and benefit all communities, especially the most vulnerable.

To assess whether dietary supplementation with couscous, a rich source of corn starch, influences breast milk production and weight gain in exclusively breastfed infants. An experimental clinical trial with crossover design was conducted involving 30 breastfeeding mothers. The participants were divided into two groups: One group consumed 70 g of couscous daily for 20 days, followed by a 20-day period without supplementation, while the other group followed the reverse order. Infant weight gain was measured on days 1, 20, and 40, and the increase in milk production was assessed using a Likert scale. Infants whose mothers consumed couscous showed a significantly greater weight gain (33.7 g/day) compared to the group without supplementation (24.6 g/day), with P-value = .007. Additionally, 60% of mothers reported a marked increase in milk production while consuming couscous. Couscous supplementation proved to be a viable strategy for enhancing both milk production and infant weight gain.

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.

The present study aims to compare the efficacy and safety of norepinephrine (NE) versus dopamine in achieving early (within 45 min of initiation) reversal of fluid-refractory septic shock in preterm neonates. A double-blind randomized controlled trial was conducted in a Level-III tertiary care hospital in Northern India. Fifty neonates born at a gestational age of <37 weeks and diagnosed with fluid-refractory septic shock till 28 days of life were randomly allocated to receive either dopamine infusion (10-20 μg/kg/min) or NE infusion (0.2-0.4 μg/kg/min). We found that the proportion of preterm neonates achieving early (within 45 min of initiation) reversal of septic shock was 11/26 (42.3%) in the dopamine group vs. 15/24 (62.5%) in the NE group, respectively [risk ratio (RR) 0.677; 95% confidence interval (CI) 0.392-1.168]. Among secondary outcomes, the proportion of neonates requiring additional vasoactive drugs was significantly less in the NE group, 8/24 (33.3%) vs. the dopamine group, 16/26 (61.5%), respectively (RR 1.846; 95% CI 1.000-3.509, P=.04). Additionally, the probability of requiring additional vasoactive drugs and remaining alive during the hospital stay were significantly higher in the NE group [hazard ratio (HR) 1.66; 95% CI 1.12-2.45, P=.01 by log-rank test]. There was no significant difference in other clinical outcomes. Among preterm neonates with fluid-refractory septic shock, NE (0.2-0.4 μg/kg/min) and dopamine (10-20 μg/kg/min) had comparable efficacy and safety.

Diarrheal diseases are a leading cause of morbidity and mortality in children globally, and antibiotics are often inappropriately used in the management of pediatric diarrhea. This study explores how parents' expectations influence the prescription of antibiotics for pediatric diarrhea in Bangladesh. We used qualitative methods to explore parents' expectations when bringing their child with diarrhea to hospital and how physicians perceive and manage expectations. We conducted interviews with 36 parents and 18 hospital physicians across three hospitals. Data analysis followed an applied thematic analysis framework. Parents expected a higher quality of care in the hospital setting, including diagnostic testing, medication, and psychosocial support. Most parents did not expect antibiotics as treatment for pediatric diarrhea, yet most parents expressed a belief that antibiotics were superior to other medications. Physicians recognized this parental belief about antibiotic superiority, but some mistakenly assumed parents universally expected antibiotics. Physicians stated that the most common form of managing parents' expectations is via educational counseling. Physicians' assumptions that parents expect to receive antibiotics may lead to inappropriate antibiotic prescription and be a source of frustration for both parties. Shared decision-making interventions can assist physicians in exploring and managing parent expectations to promote antibiotic stewardship.

Effective neonatal pain management, particularly during procedures like vaccination, is vital to prevent immediate distress and potential long-term negative consequences. While non-pharmacological methods exist, direct comparisons of breastfeeding and oral dextrose for specific vaccinations, such as Bacillus Calmette-Guérin (BCG), are limited. This comparison is especially pertinent for low- and middle-income countries (LMICs) needing accessible, cost-effective strategies. This study compared the effectiveness of direct breastfeeding vs. oral dextrose for pain management during BCG vaccination in neonates. An open-label randomized controlled trial was conducted at a maternity home in North Delhi, India. One hundred thirty stable term neonates were randomized to receive either direct breastfeeding (n = 65) or 25% oral dextrose solution (n = 65) during BCG vaccination. Pain was assessed as the primary outcome using the Neonatal Infant Pain Scale (NIPS). Secondary outcomes included heart rate, oxygen saturation, and crying duration. The mean NIPS scores were significantly lower in the breastfeeding group than in the dextrose group (0.68 ± 1.42 vs. 3.65 ± 2.41, P-value < .001). A substantially higher proportion of breastfed infants experienced no pain (95.4% vs. 44.6%, P-value < .001). Crying duration was also significantly shorter in the breastfeeding group (1.57 ± 4.36 s vs. 11.77 ± 10.87 s, P-value < .001). Direct breastfeeding is significantly more effective than oral dextrose for managing neonatal pain during BCG vaccination. Given its cost-effectiveness, accessibility, and cultural acceptability, breastfeeding should be prioritized as the standard pain management strategy for this procedure in resource-limited settings like LMICs. Healthcare providers should routinely implement breastfeeding for neonatal vaccination pain relief. CRTI registration: CTRI/2021/12/038491.