Journal of Tropical Pediatrics最新文献

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.

Failure to thrive (FTT) is a commonly used term in pediatric clinical practice, referring to a significant deviation from normal growth patterns. It can have multiple adverse effects on a child, including developmental delays, intellectual deficits, and insecure attachment. Inadequate nutritional intake is the most frequent underlying cause. This study aims to identify the risk factors contributing to FTT in infants in a rural North Indian setting. A case-control study was conducted on infants aged 2-12 months admitted to the pediatric ward of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. Detailed histories, clinical examinations, and relevant laboratory investigations were performed for all enrolled patients. Among the 456 study participants, 152 infants (33.33%) were diagnosed with FTT. The majority of cases (92.1%) were from rural areas. Multivariate regression analysis identified key independent risk factors for FTT, including rural residence, incomplete or lack of immunization, absence of exclusive breastfeeding, and lack of timely complementary feeding. This study underscores the significant role of rural residency, inadequate immunization, absence of exclusive breastfeeding, and delayed complementary feeding in increasing the risk of FTT among infants aged 2-12 months in rural North India. Early identification of these risk factors, timely diagnosis, and appropriate interventions are crucial for improving child health outcomes. It will also help in the efficient allocation of healthcare resources.

Red blood cell (RBC) transfusion is crucial in treating anemia in the pediatric intensive care unit (PICU), though safety and necessity concerns persist. This prospective observational study examined the frequency and predictors of RBC transfusions among critically ill children, highlighting implications for low- and middle-income countries (LMICs). A single-center observational study enrolled 104 children admitted to a PICU from January to September 2021. Demographic details, past medical history, Pediatric Index of Mortality-3 scores, sedation, inotrope administration, ventilator-associated pneumonia (VAP), new-onset shock, respiratory failure, sepsis, renal failure, new or progressive multiple organ dysfunction syndrome (MODS), and duration of ventilation were recorded. Our results showed that 37 patients (35.6%) received RBC transfusions. The mean pre-transfusion hemoglobin level was 6.58 grams per deciliter (g/dl) (SD 1.71). The transfused group required more sedation (P < .001) and vasoactive agents (P < .001), had longer PICU stays (P = .013), and developed VAP (P = .037), new-onset shock (P = .025), respiratory failure (P = .021), and MODS (P = .023) more often than the non-transfused group. Logistic regression analysis showed that hemoglobin >10 g/dl at admission reduced the odds of RBC transfusion [odds ratio (OR) = 0.57, confidence interval (CI) = 0.43-0.74], while sepsis at admission increased the odds (OR = 3.24, CI = 1.09-9.60). The current study demonstrates that about one-third of critically ill children received RBC transfusions. Hemoglobin above 10 g/dl at admission was associated with significantly lower odds of RBC transfusion, while sepsis at admission significantly increased the odds. These findings are particularly relevant for LMICs, where resource constraints necessitate careful evaluation of transfusion practices to optimize patient outcomes and resource utilization.

Serological studies in infants can provide valuable information on the degree of protection conferred by IgG maternal passive transfer during early life. If infant levels are inadequate, protection may be incomplete, increasing the risk of life-threatening diseases such as pertussis and measles, before immunization completion. In addition, HIV infection, -highly prevalent in African countries like Malawi-may impair transplacental antibody transfer. We determined anti-Pertussis Toxin (PT) and anti-measles IgG in 86 6-week-old infants, born to mothers living with HIV (HIV-exposed uninfected, HEU, n = 58) and to HIV-negative mothers (HIV-unexposed uninfected, HUU, n = 28). The HEU group was divided into two subgroups: Infants born to mothers who initiated antiretroviral therapy (ART) during pregnancy (Short-ART, SA-HEU group, n = 29) or already in stable ART (Long-term ART, LA-HEU group, n = 29). The mean anti-PT and anti-measles IgG levels (1.97 IU/ml and 32.9 mIU/ml, respectively) were comparable between the HUU and HEU infants. Overall, only 12.8% and 18.6% of all infants had IgG levels above the protective thresholds for pertussis and measles, respectively. The duration of ART significantly influenced the infant's serological profile, with SA-HEU infants showing significantly lower IgG levels compared to both HUU and LA-HEU infants. Protecting infants during early life remains a significant health challenge in many middle and low-income countries. Achieving better early serological protection requires the implementation of diverse vaccination strategies. This study emphasizes the crucial importance for women living with HIV to be on stable ART before pregnancy.