Journal of Tropical Pediatrics最新文献

India is an endemic country for scrub typhus, a common rickettsial infection caused by Orientia tsutsugamushi contracted through the bite of infected mites. Though relatively common in the pediatric population, early diagnosis sometimes becomes difficult due to its atypical presentation. We reported five febrile children who had varied presentations like convulsion, jaundice, generalized edema, or features like Kawasaki disease, and only one had pathognomonic eschar. They were diagnosed with acute disseminated encephalomyelitis, nephrotic syndrome, hepatitis, or Kawasaki phenotype hyperinflammatory syndrome along with positive scrub typhus IgM in all cases. They recovered with doxycycline and other disease-specific treatments like intravenous methylprednisolone, immunoglobulin, and oral prednisolone. All of them were discharged in stable condition. The variety and rarity of some presentations of pediatric scrub typhus should prompt pediatricians to have a high index of suspicion for scrub typhus in cases that present similarly to these cases.

To assess the knowledge of health workers on neonatal management, describe neonatal care in the first 2 h of life, and health outcomes of neonates in Tanzania. A prospective cohort study was performed from January to April 2022 at a district hospital on Pemba Island, Tanzania. Women admitted in active labor, and their neonates were eligible for inclusion. Standardized observations in the first 2 h after birth, followed by a clinical examination, and interviews on days 7 and 28 were performed. Health workers were given multiple-choice questions on neonatal management. Immediate skin-to-skin care was performed in 23% of neonates and breastfeeding was initiated during the first hour of life in 46%. At 2 h of life, 10% had blood glucose <2.5 mmol/L (mean: 3.71, SD 1.1), 44.6% had hypothermia with temperature <36.5°C (mean: 36.5, SD 0.5), and 2% low saturation <90%. Health workers had on average 42% correct answers on "neonatal management". The neonatal mortality rate (NMR) corresponds to 23 per 1000 livebirths. Considerable challenges in neonatal care were identified, including low-cost, high-impact interventions such as skin-to-skin care and immediate breastfeeding. The NMR was above the Sustainable Development Goal target. Further research is needed to assess the impact of training on neonatal care and outcomes in this and similar settings.

Trial registration: Clinical Trial Registry of India (CRTI/2020/02/023529).

Managing West syndrome (WS) becomes arduous in regions where access to adrenocorticotropic hormone and vigabatrin is limited, particularly in developing nations. This study aimed to evaluate the efficacy of very high-dose oral prednisolone in children diagnosed with WS. Children aged 2-36 months presenting with WS were consecutively enrolled and given oral prednisolone @ 8 mg/kg/day (maximum 40 mg) for two weeks followed by tapering doses over the subsequent two weeks. Weekly follow-ups were conducted until therapy completion, followed by bi-weekly assessments for three months. Responses (primary outcome) were assessed at two weeks and categorized as complete (spasm-free), partial (>25% reduction), or no response (<25% reduction). Neurodevelopmental outcomes, clinical-radiological profiles, safety, and therapy response predictors were also assessed. Of the 80 children, 73.7% exhibited a complete response, while 21.2% and 5% showed partial and no response, respectively. The mean age at spasm onset and presentation was 4.98 ± 4.37 months and 14.36 ± 7.13 months, respectively. Perinatal brain injury accounted for 87.5% of WS cases. Adverse effects, including weight gain (8.7%), irritability, hypertension, and disturbed sleep (3.7% each), were noted. Spasm cessation at 2 weeks, appropriate gestational age, and the absence of other seizure types were predictive of a favorable response. High-dose oral prednisolone emerges as an effective, low-cost, and safer first-line treatment option with minimal adverse effects in the Uttar Pradesh region in India, and this would likely be true in other resource-limited settings.

Septic pulmonary embolism (SPE) is a rare, life-threatening disease in children. We assessed the clinical, microbiological, radiological, and treatment results of patients who developed SPE due to Staphylococcus aureus (S. aureus). We retrospectively reviewed the medical records of patients with SPE associated with S. aureus between 2012 and 2023. Six patients were included in the study; the median age was 13 years (range: 9-16 years), and four (66.7%) of them were boys. At admission, the most common complaints were chest pain (83.3%), respiratory distress (83.3%), limb swelling (83.3%), limitation of movement in the extremities (83.3%), fever (50%), fatigue (50%), and cough (16.7%). Extrapulmonary septic foci were identified as follows: septic arthritis in four patients (66.7%), soft tissue infection in one patient (16.7%), and deep vein thrombosis in one patient (16.7%). Methicillin-resistant S. aureus was the most common causative pathogen (66.7%) and methicillin-susceptible S. aureus was found in 33% of patients. The median length of hospital stay was 43.5 days (range: 25-45 days). Three (50%) patients required intensive care, and one required mechanical ventilation support. No mortality was observed. In our study, the clinical and radiological features of staphylococcal SPE in children were nonspecific, similar to the literature. Although no mortality was observed in our study, previous studies have reported mortality rates of up to 11.8% in children with SPE. Early diagnosis, appropriate antibiotic treatment, and respiratory support are important in patients with SPE, especially in low-income settings where timely access to healthcare and diagnostic resources may be limited.

Congenital syphilis (CS) is transmitted to the fetus through the transplacental route at any stage of gestation when the pregnant women are either untreated or inadequately treated. In this study, we aimed to analyze trends in epidemiological indicators of CS in Brazil. This is a cross-sectional study utilizing data on CS across Brazilian regions from 1 January 2012 to 31 December 2021. Epidemiological indicators such as incidence, prevalence, and case-fatality rates were calculated. During the evaluated period, 192 055 CS cases were recorded in Brazil. Among pregnant women who underwent prenatal care, 58.5% were diagnosed during pregnancy, 33.9% at the time of birth, and 7.5% after birth. In 77.5% of the notifications, the partners were not treated. The average number of cases diagnosed during prenatal care was 5.6 times higher than those not reported. The Southeast region presented the highest incidence rate per 1000 live births, whereas the Midwest region had the lowest incidence. Despite an increase in rates across all regions and Brazil overall, there was no significant difference (P-value > .05) between the means for the two evaluated periods. However, there was a significant decrease (P-value < .05) in the case-fatality rate in the Northeast (1.9%-1.25%) and South (2.15%-0.92%) regions, as well as throughout Brazil (from 1.77% to 1.24%). The findings indicate that the incidence rates of CS continue to rise, suggesting that the disease remains a significant public health issue in Brazil. Effective preventive measures are urgently required.

Anaemia among adolescents is a worldwide health problem; however, data on anaemia among adolescents in Sudan are scarce. A cross-sectional study was conducted to investigate the prevalence and associated factors of anaemia and iron-deficiency anaemia among adolescent schoolchildren in northern Sudan. Socio-demographic information was collected using a questionnaire. A total of 309 adolescents (52.4% female and 47.6% male) were enrolled in the study. Seventy-five (24.3%) adolescents had anaemia, and none had severe anaemia. In the multivariate analysis, history of pica [adjusted odds ratio (AOR)  =  2.30, 95% confidence interval (CI) = 1.31-4.02] was associated with increased odds of anaemia, and an increased level of serum ferritin (AOR  =  0.97, 95% CI = 0.95-0.99) was associated with decreased odds of anaemia. Of the adolescents, 189 (61.2%) and 55 (17.8%) had iron deficiency and iron-deficiency anaemia, respectively. In the multivariate analysis, being female (AOR  =  3.13, 95% CI = 1.88-5.23) and having a history of pica (AOR  =  1.85, 95% CI = 1.03-3.31) were associated with increased odds of iron deficiency. This study showed a high prevalence of anaemia and iron-deficiency anaemia among adolescents in this part of Sudan, which was associated with a history of pica.

Evidence on long-term outcomes of children receiving antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is of utmost importance to optimize current and future therapeutic strategies for HIV. We sought to ascertain the long-term responses among ART-experienced children and their potential implications. A retrospective, observational, facility-based cohort study was conducted among 136 ART-experienced children monitored for 10 years (2007-2017) at the Essos Hospital Centre in Yaoundé, Cameroon. Primary outcomes were good clinical response defined as the World Health Organization (WHO) clinical stage 1/2, immune restoration as CD4 >500 cells/mm3, viral suppression (VS) as viral load (VL) <1000, or viral undetectability as VL <40 copies/ml at the last follow-up and their predictors (P < .05). At ART initiation among the 90 eligible children, median (interquartile range) age was 29.5 (11-60) months, 53.3% were males, 34.5% were at WHO clinical stage 1/2, median-CD4 was 497 cells/mm3, and initial ART-regimens were mainly zidovudine-lamivudine-nevirapine (85.5%) and zidovudine-lamivudine-efavirenz (12.2%). After 10 years of follow-up, 36.7% were switched to protease-based ART regimens, those at WHO clinical stage 1/2 improved to 75.5%; median-CD4 increased to 854 cells/mm3; 83.3% achieved VS, while only 10% achieved viral undetectability. Following multivariate analysis, no predictor of VS or immune recovery was identified (P > .05). In this LMIC, long-term outcomes of children on ART appear encouraging, characterized by moderate VS rate and immune recovery. However, challenges in achieving viral undetectability indicate continuous viral replication and risks of drug resistance emergence that may jeopardize effectiveness of future paediatric ART strategies.

Transcutaneous bilirubinometry (TcB) is a recognized tool to monitor neonatal hyperbilirubinemia, demonstrating a high correlation with total serum bilirubin (TSB) before phototherapy. However, once phototherapy is started, TcB may become unreliable. To evaluate the correlation and agreement of TcB measured under variously patched skin at different sites (a coin over the sternum, eye shield over the forehead, and diaper area at the back) with TSB. One hundred and ten neonates requiring phototherapy were enrolled. TcB was noted at the three sites using a Drager JM-105 bilirubinometer. TSB was measured before and after phototherapy. Paired t-test, correlation, and Bland-Altman limits of agreement (LOA) analysis were performed. Before phototherapy, the mean TcB values (mg/dl) at the forehead, sternum, and back were 14.4 ± 3.25, 14.8 ± 3.06, and 12.05 ± 3.05, respectively, compared to TSB of 14.71 ± 3.35. All three sites showed a strong positive correlation between TcB and TSB, and the range of LOA (mg/dl) was the narrowest over the sternum (-2.99, 3.18). After phototherapy, the mean TcB values at the forehead, sternum, and back were 8.97 ± 2.98, 10.27 ± 2.87, and 7.92 ± 2.29, respectively, compared to the TSB of 10.78 ± 2.70. A decrease in correlation between TcB and TSB was noted over all the sites, with the best correlation remaining over the sternum (0.83). To conclude, the sternum showed the best LOA (-3.74, 2.73) among the three patch-covered sites. TcB at sternum with coin-patch displayed the best correlation and agreement with TSB, before and after phototherapy compared to the forehead and back.

This study aimed to describe the clinical features of preterm neonatal gastrointestinal perforation (GIP) and evaluate the prognostic factors. This retrospective study comprised 191 preterm neonates diagnosed with GIP, who were categorized into survival and non-survival groups. Clinical and demographic data, laboratory and imaging features, and outcomes were retrospectively collected. Univariate and multivariate logistic regression analyses were conducted to identify independent prognostic factors. The median gestational age was 34 weeks, and the median birth weight was 2000 g. The overall mortality in the study cohort was 25.1%. The median age of onset of gastric perforation was 3 days (range: 1-11 days), while it was 7.5 days (range: 1-30 days) for intestinal perforation. Abdominal distension was the most common symptom in 184/191 (96.3%) subjects. Ninety-one (47.6%) neonates were diagnosed with a complication of necrotizing enterocolitis. Finally, three independent prognostic factors were identified: severe acidosis (OR: 7.604; 95% CI: 1.424-51.910; P = .025), shock (5.131; 2.419-11.266; P < .001), and coagulopathy (3.269; 1.511-7.431; P = .003). Severe acidosis, shock, and coagulopathy are independent prognostic factors in preterm neonates with GIP. Indexes of systemic status evaluation should be given more attention when treating GIP in premature infants.