Journal of Tropical Pediatrics最新文献

Diarrhoeal diseases remain a significant public health concern globally, particularly among under-five children. Understanding the factors influencing diarrhoea prevalence and treatment practices is crucial for improving child health outcomes. Hence, this study aimed to assess the burden, determinants, and management practices of diarrhoeal diseases among under-five children in India. We conducted a secondary data analysis of NFHS-5, covering 707 districts across India. The survey employed a stratified two-stage sampling method, and analysis included 186 920 under-five children. Poisson regression was utilized for identifying determinants of diarrhoeal burden and health-seeking behaviour and reported as adjusted prevalence ratio with 95% confidence interval. Prevalence of diarrhoea in under-five children has decreased from 9.5% in 2015-16 to the current estimate of 7.5% in 2019-21. Health seeking behaviour for diarrhoea has changed from 76.2% in 2015-16 to 76.8% in 2019-21. Age, gender, birth weight, malnutrition, maternal age, and education level were significantly associated with diarrhoea prevalence. Geographical region and wealth index influenced health-seeking behaviour towards diarrhoeal illness. The study shows a marginal decline in the diarrhoeal prevalence among children under-five years in India. Key determinants identified highlight the critical areas where targeted interventions are urgently needed.

Early differentiation between severe multi-inflammatory syndrome in children (MIS-C) and severe presentations of dengue, scrub typhus, and other endemic tropical infections could help clinicians devise appropriate treatment strategies. This study aims to identify the diagnostic markers that may be used to discriminate between MIS-C versus endemic tropical infections, namely dengue and scrub typhus, which frequently occur in endemic areas. A retrospective study was conducted in a pediatric intensive care unit (PICU) of a tertiary care center in New Delhi, India between 2020 and 2023. Comparative analysis of 33 children diagnosed with MIS-C was done versus 77 children with five endemic tropical infections-dengue, scrub typhus, typhoid fever, malaria, and leptospirosis. Rash [63.63% vs. 31.64% (P = 0.005)], conjunctival redness [63.63% vs. 8.86% (P < 0.001)], and altered sensorium [45.45% vs. 22.78% (P = 0.031)] were seen in a greater proportion of MIS-C cases than those with tropical infections. C-reactive protein (CRP) (mg/dl) was significantly higher in children with MIS-C versus those with tropical infections [176.1 (112.61, 198.32) vs. 9.25 (24.05, 69.38), P ≤ 0.001]. Ferritin and lactate dehydrogenase (LDH) were observed to be significantly higher in children with tropical infections compared to those with MIS-C. Using multivariable logistic regression analysis, the odds of having a rash were higher among children with MIS-C than those with dengue [OR = 8.07 (95% CI: 1.22-53.48, P = 0.03)]; followed by altered sensorium [OR = 16.04 (95% CI: 2.06-124.62, P = 0.008)]; myocardial involvement [OR = 7.18 (95% CI: 1.12-45.93, P = 0.037)]; and CRP (>50 mg/dl) [OR = 17.59 (95% CI: 2.69-114.92, P = 0.003)]. The findings of our study suggest that several clinical and laboratory measures could potentially distinguish between patients with severe MIS-C and endemic tropical infections. Clinical markers such as rash, altered sensorium, myocardial involvement, and shock were seen in a greater proportion of cases with MIS-C. Inflammatory markers such as CRP were higher in children with MIS-C, whereas ferritin and LDH were higher in dengue, scrub typhus, typhoid fever, malaria, and leptospirosis.

Vaccine-preventable diseases (VPD) account for a major proportion of childhood morbidity and mortality in developing countries. This study aimed to evaluate the seroprotection status of common VPD in children with type 1 diabetes mellitus (T1DM). The study enrolled 38 children aged 3-18 years with T1DM and 40 age-and sex-matched healthy controls. Demographic and clinical parameters were recorded. Venous blood samples were collected to estimate glycated hemoglobin (HbA1c) and antibody titers against hepatitis B and measles, mumps, and rubella (MMR). Both groups had completed immunization for these diseases by 2 years of age. The median age was 9.5 years with mean (SD) HbA1c 11.41 (2.57) %. Adequate seroprotection against hepatitis B, MMR were 42.5%, 32.5%, 50%, and 65% in T1DM, respectively and 55%, 50%, 40%, 65% in controls, respectively (P > .05). The median (first and third quartile) antibody levels for hepatitis B and measles in T1DM were 4.32 (0, 113.67) mIU/l and 127.4 (44.78, 347.68) mIU/l, respectively, both below the seroprotection cut-offs and lower than in controls (P > 0.05). The correlation (r) of age with anti-measles, antimumps, and antirubella antibody titers was 0.326 (P = 0.040), 0.096 (P = 0.554), and 0.334 (P = 0.035), respectively, in the cases. Anti-Hepatitis B titers correlated negatively with age (r = -0.287, P = .072). Lower seroprotection (statistically insignificant) to hepatitis B and measles were observed in children with T1DM than in controls. Physicians should consider surveillance of hepatitis B and measles, mumps, and rubella seroprotection in T1DM to evaluate the need for further boosters. Larger and more robust studies are needed on seroprotection in patients with T1DM.

Bacillus Calmette-Guérin (BCG) vaccine has an acceptable safety record; however, the vaccination can be accompanied by a variety of complications including local and systemic ones. Disseminated BCG infection is one of these complications, i.e. associated with a higher rate of mortality. In the present study, we aimed to identify the demographic and clinical characteristics of these patients. In this retrospective study, patients with a diagnosis of disseminated BCG infection admitted to Namazi Hospital between January 1991 and January 2022 were included. Demographic, clinical, and paraclinical data of these patients were collected. Statistical Package for Social Sciences was used for data management and analysis. One hundred and eighteen patients with a documented diagnosis of disseminated BCG infection were included in the study. The age range was between 1 and 85 months; however, the majority of them were infants. Immunodeficiency was detected in more than half the patients (51.7%) with severe combined immunodeficiency on the top. Forty-three patients, 36.4%, did not survive the disease. The age of the patients and the status of their immune systems were significantly associated with their outcomes in the hospital course. Disseminated BCG infection may be the first manifestation of an underlying immunodeficiency. The study showed that the common presentations of this condition, such as fever, lymphadenopathy, and failure to thrive, can mimic those of many other pediatric diseases. Given its high mortality rate, affecting over a third of our study population, thorough history-taking and careful examination are essential to avoid missing the diagnosis.

Introduction: Paediatric trauma is an ever-rising problem in low- and middle-income (LMIC) countries. Recent studies have demonstrated that children with lower injury scores are more likely to die in LMIC countries as compared to developed countries. We conducted this study to assess the need for a dedicated trauma training curriculum relevant to the epidemiology of paediatric injuries in LMIC countries.

Methods: We conducted the study in the apex trauma training site in India, wherein a predesigned questionnaire was circulated to understand the need for additional trauma training for children.

Results: A total of 642 trauma care providers out of 800 (response rate is 80.25%) completed the study. Eighty-six per cent (552/642) of trauma care providers felt the need for paediatric trauma training. Only 40% (255/642) of trauma providers were confident in handling children.

Conclusion: In an anonymous survey, trauma care providers in India admit that they need more specific paediatric trauma training because the majority of them are not confident in handling child victims of trauma. Furthermore, they felt the best solution would be to create paediatric trauma centres, instead of caring for children in adult centres for traumas. Further studies are needed to discover if the development of a standardized Paediatric Trauma Resuscitation Module for trauma care providers can increase their confidence in caring for children who are victims of road injury or other traumas in low- and middle-income countries, and if specialized paediatric trauma centres would indeed decrease morbidity and mortality of children who experience trauma in LMIC countries.

Perinatal asphyxia (PA) is a global health concern associated with long-term morbidity and significant mortality. Limited finance and inadequate facilities are the bane of the low- and middle-income countries (LMICs) making the diagnosis of PA challenging. The identification of cheap, simple, specific, and sensitive, biochemical parameter as an alternative to blood gas analysis would improve the assessment of PA in LMICs. This study is designed to assess the utility of umbilical cord arterial blood (UCAB) lactate in diagnosis and prognosis of PA among term babies. This was a prospective, cross-sectional analytical study done at UBTH over a 7-month period. The inclusion criteria for PA were documented risk factors, Apearance, Pulse, Grimace, Activity, Respiration (APGAR) score of <7 in 5 minutes, and umbilical cord pH ≤7.25. Samples were collected from the umbilical cord segments of 132 study participants and analysed using Abbott i-STAT. Sixty-six asphyxiated babies were the subjects for this study. The median (interquartile range) UCAB lactate value of the asphyxiated newborns was 7.23 (5.90-9.41) mmol/l which is significantly higher than the apparently healthy newborns of 2.97 (2.27-3.82) mmol/l (U = 4175.50; P < .001). The optimal diagnostic cut-off value of UCAB lactate in the diagnosis of PA was >5.1 mmol/l, with a sensitivity of 89.4% and specificity of 90.9%. The optimal cut-off value of UCAB lactate in predicting short-term adverse neonatal outcome (moderate to severe encephalopathy) was >8.32 mmol/l, having a sensitivity of 100% and specificity of 94.7%. UCAB lactate shows a good performance in the diagnosis of PA and prediction of short-term outcome among term neonates.

Data about epidemiologic and microbiologic patterns of neonatal sepsis in specific regions of low- and middle-income countries can help improve management and stimulate prevention efforts. We conducted a multicentre study within a large metropolitan region in South India to describe the burden of neonatal sepsis; and identify the antimicrobial sensitivity patterns of causative organisms. In a collaborative network of six neonatal intensive care units, standardized data were collected on every admitted neonate with a positive blood culture from June 2020 to May 2022. The frequency of sepsis, the organisms, antimicrobial resistance patterns, and mortality were analysed. Factors associated with lack of 'on-target' initial empirical antibiotic therapy were identified through univariate and multivariate analysis. Among 6229 admissions, the incidence of sepsis was 3.5%. Klebsiella (30%), Coagulase-negative staphylococcus (13%), and Escherichia coli (10%) were the commonest organisms. The overall incidence of multidrug resistance among Gram-negative organisms was 26%, with organism-specific incidence as follows: Klebsiella (48%), Acinetobacter (81%), and E. coli (45%). The organisms were sensitive to one or more of the initial empirical antibiotics used ('on-target') in 48% [95% confidence interval (CI) 45-58%] of cases. Mortality was higher in those neonates where initial antibiotic therapy was not 'on-target' (Relative risk (RR): 2.2, 95% CI 1.06-4.9). To conclude gram-negative septicaemia constituted 60% of the burden of neonatal sepsis. Klebsiella pneumonia was the predominant organism. Multidrug resistant organisms were highly prevalent. Initial empirical antibiotic therapy was not 'on-target' more than 50% of the time and was associated with higher mortality.

A higher risk for kidney disease in aboriginal populations has been proposed but it has not been established in their children. Likewise, there is a lack of studies focused on early markers of kidney disease in South American indigenous children. A descriptive prevalence study with an exploratory analysis was conducted between November 2015 and April 2018 on 249 indigenous children aged 5-18 years from the "Institución Educativa Agropecuaria Pueblo Totoroés" in the Totoró indigenous reserve. Eighty-five percent of subjects received exclusive breastfeeding. Spontaneous proteinuria was found in nine subjects, and in one case the proteinuria persisted in a second sample. Isolated hematuria was seen in 1.6% of subjects and blood pressure measurement over the 95th percentile in 7.2%. Overweight and obesity was related to hematuria (P = .009) but weakly related to transient proteinuria (P = .06). Some urinalyses (3.6%) were suggestive of urinary infection, but urine culture was negative in all cases. Hematuria and proteinuria in indigenous children from Totoró are transient and related to overweight and obesity. Early markers of kidney disease can be applied to other indigenous communities. A lower prevalence of chronic underweight than the general Colombian indigenous population was found, which is proposed to be related to prolonged breastfeeding.

Paediatric septic shock is a life-threatening condition with high global morbidity and mortality rates. Prior guidelines for paediatric septic shock demonstrated varying levels of effectiveness. In 2017, the institutional paediatric septic shock guidelines were established, emphasizing three pivotal components: prompt recognition, early and appropriate resuscitation, and organ support with intensive stabilization. Herein, we aimed to assess the effect of paediatric septic shock guidelines on mortality and clinical outcomes. This single-centre retrospective cohort study investigating the pre- and postimplementation of paediatric septic shock guidelines was conducted in patients aged 1 month to 15 years diagnosed with septic shock from January 2014 to December 2022. The effectiveness of the guideline implementation was evaluated through propensity matching analysis to compare 30-day in-hospital mortality rates. Adherence to key components of the guidelines was also assessed. In total, 71 and 106 paediatric patients with septic shock were admitted to the paediatric intensive care unit during the pre- and postguideline periods, respectively. The postguideline group exhibited a significant reduction in mortality [adjusted odds ratio (aOR): 0.29, 95% confidence interval (CI): 0.12-0.71, P = .007] and a decrease in respiratory dysfunction (aOR: 0.40, 95% CI: 0.18-0.91, P = .03). Guideline adherence revealed a substantial increase in the use of peripheral inotropes and noninvasive cardiac monitoring. The number needed to treat for the protocol to prevent death was six. The implementation of the paediatric septic shock guidelines, emphasizing early shock recognition, prompt resuscitation, infection control, and appropriate organ management in intensive care, significantly improved outcomes.