Paediatrics and International Child Health最新文献

Objectives: To describe the socio-demographic and clinical characteristics, treatment outcome and predictors of mortality in patients under 18 years of age with post-neonatal tetanus (PNT) in Abeokuta.

Methods: This retrospective study of 108 PNT cases admitted over a 10-year period between July 2012 and June 2022 was undertaken at two major referral hospitals in Abeokuta, Nigeria. Data on patient demographics, vaccination history, clinical features, management and outcome were analysed.

Results: PNT accounted for 0.82% of paediatric admissions during the study period. The median age was 9.0 years, with a slight male predominance (male-to-female ratio 1.1:1). None of the children under-5 were fully vaccinated; only 5.4% of older children received post-exposure prophylaxis. The lower limb was the most common site of injury. The incubation period ranged from 1 to 60 days with a median (IQR) of 8.0 (9.0) days. The case fatality rate was 18.52%. Mortality was significantly associated with lower limb wounds, rapid onset of spasms (<24 h) and the presence of autonomic dysfunction.

Conclusion: The burden of PNT in Abeokuta is considerable, driven by low vaccination coverage and delayed wound care. Prompt immunisation, early wound management and improved access to critical care are essential to reduce mortality.

Acute acalculous cholecystitis (AAC) is a rare but potentially serious disorder associated with Kawasaki disease (KD). Studies have demonstrated that patients presenting with severe abdominal symptoms owing to KD have increased resistance to intravenous immunoglobulin (IVIG) and a higher rate of coronary artery aneurysms. A 5-year-old boy was brought to the emergency department with fever, abdominal pain, vomiting and jaundice. He presented as ACC and was subsequently diagnosed with KD because the symptoms and signs he developed during admission were consistent with that. He was treated with IVIG and high-dose aspirin, and was discharged 7 days later with complete resolution of the symptoms.Abbreviations: AAC acute acalculous cholecystitis; ALT alanine transaminase; AST aspartate aminotransferase; CMV cytomegalovirus; CRP C-reactive protein; EBV Epstein-Barr virus; GGT gamma-glutamyl transferase; IVIG intravenous immunoglobulin; KD Kawasaki disease.

Background: Impaction of button batteries (BB) in children is not rare.

Aim: To conduct a systematic review of reports of oesophageal injury caused by impaction of BB in children in China.

Methods: The databases of Wanfang, VIP, China National Knowledge Internet, the Chinese Medical Association Journal and PubMed were searched for reports by Chinese authors of BB impaction published between May 2005 and July 2023. The risk factors for complications were analysed by multiple unconditional logistic regression.

Results: After excluding 95 articles which did not meet the criteria, 77 remained, with a total of 964 cases of BB impaction. Of 516 cases with complications, 402 were in children (77.9%). The most common complications were oesophageal erosions and ulceration (218/402, 54.2%), followed by oesophageal perforation (88/402, 21.1%), tracheo-oesophageal fistula (69/402, 17.2%), oesophageal stricture (38/402, 9.5%) and peri-oesophagitis (31/402, 7.7%). Regression analysis demonstrated that the duration and location of impaction were the risk factors for complications (OR 13.7 and 11.3, respectively; p < 0.05 for both).

Conclusion: BB impaction remains common and causes serious oesophageal complications in children. Widespread knowledge of the risks is essential for prevention.

In children, anaemia is an uncommon presentation of hypothyroidism. The diagnosis was delayed in two girls with auto-immune atrophic thyroiditis owing to an absence of goitre and the unusual presentation of fatigue and anaemia. The first patient was a 15-year-old girl who presented with fatigue and pallor. Results of the initial investigation were compatible with iron deficiency anaemia. However, after 2 years of iron supplementation, the anaemia had not been resolved. Owing to refractory anaemia and recent mild neutropenia, a bone marrow (BM) study was performed. The BM histopathology demonstrated hypocellular marrow, compatible with BM suppression. Tests for low thyroid hormone levels (one of the causes of BM suppression) revealed overt hypothyroidism. She also had a mildly decreased estimated glomerular filtration rate (eGFR). The second patient was a 9-year-old girl who presented with a 5-month history of fatigue and a weight gain of 4 kg in a month. Initial laboratory tests showed macrocytic anaemia, decreased eGFR and normal urinalysis. Further investigation confirmed overt hypothyroidism. After levothyroxine treatment, the anaemia was resolved in both patients and the eGFR normalised. This report demonstrates that anaemia in children can be the initial presentation of hypothyroidism. Hypothyroidism should be considered as a possible cause of anaemia, especially anaemia refractory to conventional treatment. Additionally, goitre as a clue to diagnosing acquired hypothyroidism owing to auto-immune thyroiditis might not be apparent in atrophic thyroiditis. Unrecognised hypothyroidism might lead to unnecessary investigations and delay appropriate treatment. Normalisation of thyroid function in patients with hypothyroidism results in the resolution of anaemia and the normalisation of eGFR.

Pre-school children are at highest risk for dog bites. A 2-year-old boy was bitten by a little Pinscher nano dog causing deep injuries which were not apparent on first evaluation. A few hours later he had severe respiratory failure, consistent with subglottic injury. Marked neck enlargement was caused by widespread subcutaneous emphysema. The airway oedema and superimposed systemic infection required a week of intensive care to improve and restore spontaneous breathing. Even an apparently benign bite lesion can evolve into a life-threatening respiratory condition, and there should be a high index of suspicion for every neck lesion in a child.

Pulmonary arteriovenous malformation (PAVM) is a rare, pathological, intrapulmonary, right-to-left shunt resulting from abnormal communication between the pulmonary artery and pulmonary vein. It can remain asymptomatic and/or suddenly manifest with life-threatening complications. A 13-year-old girl presented with giddiness, falling over and loss of consciousness. She was the fourth child of non-consanguineous parents, and two of her older siblings had died: a girl at 2 years of age owing to suspected pneumonia, and a boy at 8 years of age owing to falling over and convulsions. She had dyspnoea, central cyanosis, clubbing, severe hypoxaemia, polycythaemia and iron deficiency. Chest radiograph demonstrated well defined homogeneous opacity in the right hilar region. The thoracic CT angiogram revealed a large PAVM in the superior segment of the right lower lung fields. Percutaneous cardiac catheterisation and coil embolisation of the PAVM were successfully undertaken. Her oxygen saturation improved to 95-97% in room air. She remained asymptomatic during 2 months of follow-up and then by telephone for 1 year post-procedure. However, her parents have not since attended the hospital for repeat examination and scans. This case highlights the timely, successful treatment of a large PAVM in an adolescent girl and emphasises the need for awareness in paediatricians and other healthcare workers about PAVMs, which, although rare, are potentially life-threatening, especially in adolescents in whom a comorbidity such as iron deficiency could increase the risk of PAVM complications.

Background: Congenital malaria, characterised by low parasitaemia in newborns' peripheral blood, is difficult to diagnose by conventional techniques. Owing to its high sensitivity, polymerase chain reaction (PCR) allows for effective detection of low-density plasmodium infections. This study determined the prevalence of congenital malaria by PCR in newborns of mothers living in a malaria-endemic area of Kinshasa, Democratic Republic of Congo (DRC).

Methods: A total of 576 mother-newborn pairs were enrolled in two clinical trials in Kinshasa. Maternal peripheral blood was collected at enrolment. At delivery, samples were taken from maternal and newborn peripheral blood, placental blood and placental imprints.

Results: The prevalence of congenital malaria detected by PCR was 2.4% (14/576) compared with 0.9% (5/576) by microscopy. The prevalence of malaria at delivery was 8.9% (51/570), and placental malaria was 10.6% (59/556) by microscopy. At delivery, maternal malaria was significantly associated with congenital malaria [adjusted odds ratio (aOR) 16.06, 95% CI 2.6-98.5, p < 0.01). Placental malaria also increased the risk of congenital malaria (aOR 5.77, 95% CI 0.9-35.2, p = 0.05). Although 10 of 72 women (16.7%) with placental malaria gave birth to low-weight infants, the association was not statistically significant.

Conclusions: Although this first assessment of congenital malaria by PCR in DRC found a low prevalence, maternal and placental malaria at delivery were still associated with congenital malaria, highlighting the importance of maternal health in preventing neonatal infections.Abbreviations: Aor adjusted odds ratio; CI confidence interval; cOR crude odds ratio; DNA de-oxyribonucleic acid; GAPDH glyceraldehyde-3-posphate dehydrogenase; g/dL grams per decilitre; Hb haemoglobin; IQR interquartile range; IPTp-SP Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine; ITN insecticide-treated nets; PA pyronaridine-artesunate; PCR polymerase chain reaction; RDT rapid diagnostic tests; SD; standard deviation; uRDTs ultra-sensitive rapid diagnostic tests; WHO World Health Organization; µL microlitre.

The prevalence of post-tuberculous endobronchial stenosis in children is unknown and it is rarely reported. In adults, it varies from 10% to 40%. It has a variable spectrum of presentation; cough is the most common, but there can also be haemoptysis, dyspnoea, chest pain and wheezing. The non-specific symptoms and co-occurrence with parenchymal disease can delay the diagnosis. Bronchoscopy and computed tomography (CT) are the investigations of choice. Depending on the symptoms, chest imaging and bronchoscopic findings, the treatment can be conservative, medical or interventional. A 15-year-old male is presented; he was a known case of clinically and radiologically diagnosed pulmonary tuberculosis and was treated for 6 months with anti-tuberculous drugs. On presentation, there was a progressive cough, exertional dyspnoea, collapse consolidation of the left lung, ipsilateral mediastinal shift and partial stenosis of the left distal main bronchus on contrast-enhanced CT. Flexible fibre-optic bronchoscopy demonstrated atresia of the anterior segment and stenosis of the inferior lingular segment of the left bronchus with a normal right bronchus. Post-tuberculous bronchial stenosis should be focused on and managed early to prevent fibro-stenosis. Early treatment in a symptomatic patient is linked to a successful outcome. The boy showed significant clinical improvement with spirometry, chest physiotherapy and supportive measures, although the radiological features persisted.Abbreviations: ATT: anti-tuberculous therapy; CT: computed tomography; EBTB: endobronchial tuberculosis; ESR: erythrocyte sedimentation rate; HRCT: high-resolution computed tomography; LUL: left upper lobe; TB: tuberculosis.