Journal of Tropical Pediatrics最新文献

Despite effective antiretroviral therapy (ART), children born to women living with HIV but who remain uninfected (CHEU) have poorer growth compared to children born to women living without HIV (CHU). Few studies have compared growth beyond early childhood. In a cross-sectional study, we enrolled CHEU and CHU aged 3-10 years. Growth Z-scores were calculated using WHO growth standards (weight-for-age [WAZ], height-for-age [HAZ], body mass index [BMIZ] [5-10 years], and head circumference-for-age [HCZ] [3-5 years]). Growth faltering was defined as Z-scores of <-2 SDs. We compared CHEU/CHU growth Z-scores and prevalence of growth faltering using generalized linear models and binomial regression, adjusting for sociodemographic characteristics. We enrolled 2001 CHEU and 200 CHU. The median age was similar in both categories. CHEU were more likely to be orphaned and vulnerable children (22%) and to have shorter breastfeeding period (12 vs. 24 months). CHEU mothers were older, had fewer years of education, and were more likely to be single parents. Most CHEU mothers were on ART during pregnancy with the enrolled child. CHEU had significantly lower HAZ (adjusted mean difference [aMD] -0.41, 95% CI -0.66, -0.17, P = .001) and WAZ (aMD -0.25, 95% CI -0.43, -0.08, P = .005). CHEU had 1.7 times higher prevalence of stunting (HAZ <-2) in unadjusted models, which was attenuated after adjustment. There were no differences in BMIZ or HCZ. Older CHEU aged 3-10 years had lower WAZ and HAZ scores than CHU. Poorer growth outcomes persisted after adjustment for socio-economic factors, suggesting a potential role of biological factors.

Optimal nutrition is essential for overall health in all age groups. Dietary diversity is a proxy indicator of nutrient sufficiency, and current evidence suggests an association between maternal and child dietary diversity. This study examined the relationship between the dietary diversities of infants and their mothers in Thailand. A cross-sectional study was conducted among 120 pairs of healthy 6- to 12-month-old infants and mothers attending the Well Child Clinic at Songklanagarind Hospital between December 2020 and November 2021. The dietary intake of mothers and infants was assessed using a 24-h food record. Foods were categorized into 8 and 10 food groups for infants and mothers, respectively. Dietary diversity and nutritional status (body mass index) were analyzed. The common food groups consumed by infants included milk (100%), grains (83%), vitamin A-rich fruits and vegetables (81%), fruits (71%), meat (67%), and eggs (45%), while mothers most frequently consumed grains (99%), meat (97%), fruits (73%), eggs (68%), vegetables (64%), and milk (30%). Kendall's rank correlation revealed that mothers with higher dietary diversity fed their infants a similarly diverse diet (τ = 0.152, P = .04). A significant positive relationship between maternal and infant body mass indices was also observed (r2 = 0.36, P < .001). Our study found a correlation between maternal and 6- to 12-month-old infant dietary diversities and revealed a positive association between the body mass indices of mothers and infants. Our findings suggest that mothers' diets significantly affect infants' diets and nutritional status.

The continuous daily care required by children with congenital Zika syndrome (CZS) may overload the lives of caregivers. However, little is known about the factors associated with musculoskeletal symptoms experienced by caregivers. This study aimed to investigate the prevalence of musculoskeletal symptoms in caregivers of children with CZS and identify its associated factors. This cross-sectional study included caregivers of children with CZS from northeast Brazil. Musculoskeletal symptoms were assessed using the Nordic Musculoskeletal Questionnaire. Information about caregivers, pregnancy, childbirth, general aspects, and neuropsychomotor development of children with CZS were also recorded. Musculoskeletal symptoms of caregivers were analyzed using bivariate analysis and binary logistic regression. We included 41 caregivers, of whom 39 (95.12%) had musculoskeletal symptoms in the last 12 months, and 31 (75.61%) had symptoms in the last 7 days. However, less than half considered these symptoms incapacitating to require the absence from their activities (43.90%) or a medical consultation (26.83%). The presence of symptoms in at least one body region was associated with occupational activities, number of children with or without disability, caregiver age, current head circumference, child age, and ability of the child to sit without support. Musculoskeletal symptoms were not considered incapacitating by caregivers of children with CZS despite its high prevalence. The characteristics of the caregiver and children were associated with the prevalence of musculoskeletal symptoms.

To assess the diagnostic accuracy of point-of-care ultrasound against single or multiple check X-rays done to confirm central line position. This cross-sectional observational study was conducted in a tertiary neonatal intensive care unit from March 2023 to March 2024. Point-of-care Ultrasound (USG) and radiograph were performed on infants who underwent central line placement. Diagnostic accuracy of USG was presented by sensitivity, specificity, PPV, NPV, positive likelihood ratio, and negative likelihood ratio. Of the 160 central lines, 109 (68.1%) vs. 102(63.8%) central lines were defined as optimally placed on the radiograph and POCUS, respectively. The sensitivity and specificity of POCUS in confirming central line tip position were 93.58% and82.35%, respectively. The positive predictive value and the negative predictive value were 91.89% and 85.71%, respectively. The positive likelihood ratio was 5.3%, and the negative likelihood ratio was 0.08%. Overall accuracy of POCUS to radiography was 90% [95% confidence interval (CI) 84.27-94.18]. The study also revealed that a significantly shorter time was required in bedside POCUS with a mean duration of 4 minutes as compared to X-ray where the mean duration was 19 minutes. Point-of-care ultrasound can be used as an alternative to bedside radiographic examination in confirming the catheter tip position with diagnostic accuracy of 90%.

To assess the feeding characteristics and postnatal weight gain of premature small for gestational age (SGA) versus appropriate for gestational age (AGA) infants during neonatal intensive care unit stay and to investigate the association between postnatal growth failure (PGF) and neonatal variables. This retrospective study was conducted on premature infants with a birth weight ≤1500 g and a gestational age <32 weeks, born between January 2013 and June 2016. The infants were categorized into two groups: SGA (n = 42) and AGA (n = 380). The groups were compared in terms of demographics, clinical characteristics, and PGF at discharge. PGF was defined as a decrease in the z-score of more than 1.34 from birth to discharge. Multiple logistic regression analysis was used to identify variables associated with PGF. SGA infants had a longer time to achieve full enteral feeding (P = .010) and a longer duration of total parenteral nutrition (P = .001). Although the frequency of feeding intolerance was higher in SGA infants, the difference was not statistically significant (P = .056). The overall prevalence of PGF at discharge was 42% and comparable between the two groups. Late-onset sepsis, hemodynamically significant patent ductus arteriosus and lower weight z-score at fourth week of life [adjusted odds ratio (aOR) = 1.69, 95% confidence interval (CI) = 1.06-2.69, P = .027; aOR = 1.75, 95% CI = 1.14-2.68, P = .01; and aOR = 1.86, 95% CI = 1.21-2.86, P = .004, respectively) were independently associated with an increased risk of PGF. SGA infants experienced more severe growth failure at discharge compared to AGA infants. However, the rate of PGF was similar between the two groups.

Neonatal hypothermia is a major contributor to morbidity and mortality in low- and middle-income countries (LMICs). While effective in reducing hypothermia, implementation of skin-to-skin contact (SSC) is often hindered by its privacy concerns. This study aimed to evaluate the efficacy and feasibility of cloth-to-cloth contact (CCC) as an alternative to SSC in term newborns at postnatal ward, where the newborn is dressed and placed in the kangaroo position on the mother's chest without exposing her bare skin. In this randomized trial, stable term newborns in a postnatal ward were assigned to either conventional care (dressed, kept beside the mother) or CCC (dressed, held in kangaroo position with both mother and baby clothed). Axillary temperatures were recorded up to 48 hours of life, and mothers' experiences with CCC were assessed using a structured questionnaire. Eighty-seven neonates were enrolled (43 conventional care, 44 CCC), with 369 and 379 temperature recordings, respectively. Mean axillary temperatures were similar between groups up to 42 hours. At 48 hours, the CCC group had a significantly higher mean temperature [36.85 (0.26)°C] than the conventional care group [36.73 (0.28)° C] (P = .04). The overall incidence of hypothermia was comparable, except in winter, when it was higher in the conventional care group (35.2%) than in the CCC group (22.8%) (P = .008). Most mothers found CCC feasible and preferred it over conventional care. CCC is an effective and feasible intervention for preventing hypothermia in term newborns, especially during colder months in LMIC settings.

This case highlights the importance of identifying an atypical presentation of early chronic schistosomiasis, which challenges classical clinical patterns. An initial lack of response to treatment does not necessarily require a change in strategy, and clinical experience in non-endemic areas can help avoid invasive procedures. Serological diagnosis is commonly used, particularly in non-endemic regions, and it can help in monitoring treatment response in pediatric patients.

Childhood drowning is a major cause of morbidity and mortality with significant economic and social implications, especially in low- and middle-income countries. Despite this, there is a lack of good-quality epidemiological data on childhood drowning. We report the epidemiology of fatal and non-fatal unintentional childhood drowning in Malaysia between the years 2000 and 2022. Data about childhood drowning were obtained from a hospital-based registry gathered by the National Health Informatics Centre, the Ministry of Health, Malaysia. Child population data were downloaded from the Malaysian Census. Overall incidence rates (IRs), case fatality rates (CFRs), and IR and CFR by age, sex, race, and region were calculated. Binary logistic regression was used to determine the factors associated with fatality. Between the years 2000 and 2022, a total of 4247 cases of drowning were reported. IR was significantly higher among children aged 0-9, boys, Bumiputera, and the East Coast and Borneo regions. Overall CFR was 3.7%. Age, year of hospitalization, and Bumiputera were associated with CFR. The site of drowning was unspecified in 84% of cases, while for those recorded, natural water sources and swimming pools accounted for most sites. While the annual incidence of drowning has remained nearly constant throughout the years, the fatality rate has increased between 2010 and 2022. Our report provides leads for further research data requirements to understand childhood drowning epidemiology better and improve preventive measures.

The World Health Organization (WHO) recommends Xpert® MTB/RIF (Xpert) and its advanced version, Xpert® MTB/RIF Ultra (Xpert Ultra), as first-line diagnostic tests for detecting pulmonary tuberculosis (PTB) and rifampicin resistance in children suspected of having the disease. Respiratory specimens (gastric lavage/bronchoalveolar lavage/sputum/endotracheal aspirate) obtained from 116 children with presumptive PTB were simultaneously processed using liquid medium culture, Xpert assay, and Xpert Ultra assay. Among the specimens from 116 children, six were excluded due to culture contamination (n = 5) or error in Xpert Ultra results (n = 1). Among the remaining 110 specimens, 20 were positive by liquid culture. The former and latter, of the two comparator tests gave a sensitivity of 90% and 95%, respectively. The respective specificity was 93.3% and 88.9%. Xpert Ultra showed a statistically significant slightly higher sensitivity than Xpert. Xpert Ultra showed slightly higher sensitivity than Xpert, with a minimal loss in specificity, partly due to the inclusion of trace results, which help detect paucibacillary cases.

Early identification of developmental and behavioral delays could improve child's health in the long term. The aim was to determine the prevalence and explore the associated factors with child development and behavior. A cross-sectional study was carried out with Brazilian children aged 4 years old and their respective caregivers. Child's development and behavior were assessed using the Brazilian screening tool version of the Survey of Well-being of Young Children. Generalized linear models were used to analyze the associations between explicative variables and outcomes. Prevalence of suspected development delay was 28.0% and behavior problems was 39.5%. Children sex, school period, daily reading, and behavior domain were associated with development domain, while sleeping time, development domain, food insecurity, and ultraprocessed food score were associated with behavior domain. It is necessary to encourage the expansion of screening instruments in daily primary health-care practice, expand professional's specialization, and improve multisectoral integration.