Pub Date : 2021-11-01Epub Date: 2021-09-07DOI: 10.1080/20469047.2021.1890681
Lara Ferreira, Raquel Amaral, Fernanda Gomes, José Cabral
A 7-month-old boy was admitted with acute gastro-enteritis accompanied by fever and hyponatraemic dehydration. The clinical course was complicated by severe hypokalaemia and hypo-albuminaemia with anasarca. Protein-losing enteropathy (PLE) owing to Yersinia enterocolitica colitis was diagnosed and was complicated by fungal sepsis owing to Kodomaea ohmeri. Colonoscopy demonstrated multiple diffuse ulcers and sub-epithelial haemorrhages extending from the rectum to the hepatic angle. He required prolonged nutritional support comprising partial parenteral feeding for 10 days, followed by a hypo-allergenic diet until 13 months of age when cow milk was tolerated. He was discharged on a normal diet and in good health at 19 months of age.Abbreviations AVPU scale: A alert, V verbally responsive, P painfully responsive, U unresponsive; CMV: cytomegalovirus; EBV: Epstein-Barr virus; HIV: human immunodeficiency virus; Ig: immunoglobulin; IBD: inflammatory bowel disease; IPEX: immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome; PICU: paediatric intensive care unit; PLE: protein-losing enteropathy.
{"title":"Protein-losing enteropathy caused by <i>Yersinia enterocolitica</i> colitis.","authors":"Lara Ferreira, Raquel Amaral, Fernanda Gomes, José Cabral","doi":"10.1080/20469047.2021.1890681","DOIUrl":"https://doi.org/10.1080/20469047.2021.1890681","url":null,"abstract":"<p><p>A 7-month-old boy was admitted with acute gastro-enteritis accompanied by fever and hyponatraemic dehydration. The clinical course was complicated by severe hypokalaemia and hypo-albuminaemia with anasarca. Protein-losing enteropathy (PLE) owing to <i>Yersinia enterocolitica</i> colitis was diagnosed and was complicated by fungal sepsis owing to <i>Kodomaea ohmeri</i>. Colonoscopy demonstrated multiple diffuse ulcers and sub-epithelial haemorrhages extending from the rectum to the hepatic angle. He required prolonged nutritional support comprising partial parenteral feeding for 10 days, followed by a hypo-allergenic diet until 13 months of age when cow milk was tolerated. He was discharged on a normal diet and in good health at 19 months of age.<b>Abbreviations</b> AVPU scale: A alert, V verbally responsive, P painfully responsive, U unresponsive; CMV: cytomegalovirus; EBV: Epstein-Barr virus; HIV: human immunodeficiency virus; Ig: immunoglobulin; IBD: inflammatory bowel disease; IPEX: immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome; PICU: paediatric intensive care unit; PLE: protein-losing enteropathy.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39391114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haemolacria, also known as bloody tears, is a physical condition in which a person produces tears partially composed of blood. Multiple disorders can cause haemolacria, including trauma, inflammation, vascular lesions, vicarious menstruation, blood disorders, epistaxis, tumours and psychiatric and systemic disorders. Often, no aetiology is identified. It is usually benign, self-limiting, and the treatment depends on the cause. A 14-year-old girl presented to the paediatric emergency department with sudden onset of bloody tears from both eyes and epistaxis for the first time. A detailed history focusing on aetiological factors was unremarkable. Systemic, ocular, nasal and paranasal examination was also unremarkable. Radiological and laboratory investigations were normal, and the patient was diagnosed with idiopathic haemolacria. High-dose oral vitamin C, prophylactic iron therapy and psychological support were provided as conservative treatment. During regular follow-up, there was a spontaneous reduction in the frequency of symptoms.
{"title":"Sudden-onset haemolacria in an adolescent girl.","authors":"Ayla Akca Caglar, Halise Akca, Funda Kurt, Leman Akcan Yildiz, Pinar Nalcacioglu, Onur Buyukkoc, Emine Dibek Misirlioglu","doi":"10.1080/20469047.2021.1949563","DOIUrl":"https://doi.org/10.1080/20469047.2021.1949563","url":null,"abstract":"<p><p>Haemolacria, also known as bloody tears, is a physical condition in which a person produces tears partially composed of blood. Multiple disorders can cause haemolacria, including trauma, inflammation, vascular lesions, vicarious menstruation, blood disorders, epistaxis, tumours and psychiatric and systemic disorders. Often, no aetiology is identified. It is usually benign, self-limiting, and the treatment depends on the cause. A 14-year-old girl presented to the paediatric emergency department with sudden onset of bloody tears from both eyes and epistaxis for the first time. A detailed history focusing on aetiological factors was unremarkable. Systemic, ocular, nasal and paranasal examination was also unremarkable. Radiological and laboratory investigations were normal, and the patient was diagnosed with idiopathic haemolacria. High-dose oral vitamin C, prophylactic iron therapy and psychological support were provided as conservative treatment. During regular follow-up, there was a spontaneous reduction in the frequency of symptoms.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39194569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2021-11-16DOI: 10.1080/20469047.2021.1952818
H Simon Schaaf, James A Seddon
Tuberculous meningitis (TBM) remains the most devastating form of tuberculosis (TB). A systematic review of TBM in children reported an overall mortality risk of almost 20% [1], yet mortality has been found to be <5% in some large paediatric studies [2,3]. In several studies, severe neurological morbidity is reported in more than 50% of survivors, but this depends largely on the stage of TBM at presentation [1,4]. Because many cases go undiagnosed, little is known about the true incidence of TBM in children, and, even if diagnosed, cases may not be reported [5,6]. In Germany, a low TB-burden country, the prevalence of TBM among TB cases from 2002 to 2009 was estimated to be approximately 1% overall, but was 3.9% in children <5 years, 2.2% in children aged 5–9 years and 1.3% in children aged 10–14 years [7]. In a high TB-burden setting in the Western Cape, South Africa, 5.6% of children (<13 years) with bacteriologically confirmed TB diagnosed at hospital level between 2013 and 2017 had TBM [8]. The World Health Organization (WHO) estimated that in 2019 there were 1.19 million new cases of TB in children (0–<15 years); if 2% of these children had TBM, it would account for ~25,000 cases per year globally. This editorial briefly describes the pathogenesis of TBM in children as well as advances in diagnostics, recent developments in antimicrobial therapy and the role of therapeutic drug monitoring.
{"title":"Management of tuberculous meningitis in children.","authors":"H Simon Schaaf, James A Seddon","doi":"10.1080/20469047.2021.1952818","DOIUrl":"https://doi.org/10.1080/20469047.2021.1952818","url":null,"abstract":"Tuberculous meningitis (TBM) remains the most devastating form of tuberculosis (TB). A systematic review of TBM in children reported an overall mortality risk of almost 20% [1], yet mortality has been found to be <5% in some large paediatric studies [2,3]. In several studies, severe neurological morbidity is reported in more than 50% of survivors, but this depends largely on the stage of TBM at presentation [1,4]. Because many cases go undiagnosed, little is known about the true incidence of TBM in children, and, even if diagnosed, cases may not be reported [5,6]. In Germany, a low TB-burden country, the prevalence of TBM among TB cases from 2002 to 2009 was estimated to be approximately 1% overall, but was 3.9% in children <5 years, 2.2% in children aged 5–9 years and 1.3% in children aged 10–14 years [7]. In a high TB-burden setting in the Western Cape, South Africa, 5.6% of children (<13 years) with bacteriologically confirmed TB diagnosed at hospital level between 2013 and 2017 had TBM [8]. The World Health Organization (WHO) estimated that in 2019 there were 1.19 million new cases of TB in children (0–<15 years); if 2% of these children had TBM, it would account for ~25,000 cases per year globally. This editorial briefly describes the pathogenesis of TBM in children as well as advances in diagnostics, recent developments in antimicrobial therapy and the role of therapeutic drug monitoring.","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39736970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01Epub Date: 2022-01-23DOI: 10.1080/20469047.2022.2027324
Indah K Murni, Nadya Arafuri, Andrew C Steer, M Taufik Wirawan, Fransisca G W Remi, Noormanto Noormanto, Sasmito Nugroho
Background: Rheumatic heart disease (RHD) is associated with high morbidity and mortality, especially in those with severe RHD or progression of valvular disease (VD). Evaluation of the factors that predict valvular progression is important in order to improve clinical outcome.
Aim: To evaluate outcome and clinical predictors of valvular progression in children with newly diagnosed RHD.
Methods: A retrospective cohort study was conducted in children with newly diagnosed RHD at Dr Sardjito Hospital, Yogyakarta, Indonesia during 2013-2020. Clinical and echocardiography data at the time of diagnosis were collected and patients were followed up for 1 year. Echocardiography evaluations were undertaken to determine the progression of VD. Independent predictors of valvular progression were identified by Cox regression analysis.
Results: A total of 77 patients were recruited, 36 (46.7%) of whom were male, and the median age (range) was 12.3 years (5.9-17.8). Thirty-three (42.8%) had progression of VD in the year after diagnosis. By multivariable analysis, an age at diagnosis of >10 years and high C-reactive protein (CRP) were independently associated with an increased risk of valvular progression with an adjusted hazard ratio (95% CI) of 3.23 (1.09-9.60) and 3.69 (1.45-9.67), respectively.
Conclusion: After only 1 year of follow-up, approximately four in 10 children with newly diagnosed RHD developed progression of VD. An increased risk of valvular progression was associated with being over 10 years of age and a high level of CRP.
{"title":"Outcome in children with newly diagnosed rheumatic heart disease in Indonesia.","authors":"Indah K Murni, Nadya Arafuri, Andrew C Steer, M Taufik Wirawan, Fransisca G W Remi, Noormanto Noormanto, Sasmito Nugroho","doi":"10.1080/20469047.2022.2027324","DOIUrl":"https://doi.org/10.1080/20469047.2022.2027324","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic heart disease (RHD) is associated with high morbidity and mortality, especially in those with severe RHD or progression of valvular disease (VD). Evaluation of the factors that predict valvular progression is important in order to improve clinical outcome.</p><p><strong>Aim: </strong>To evaluate outcome and clinical predictors of valvular progression in children with newly diagnosed RHD.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in children with newly diagnosed RHD at Dr Sardjito Hospital, Yogyakarta, Indonesia during 2013-2020. Clinical and echocardiography data at the time of diagnosis were collected and patients were followed up for 1 year. Echocardiography evaluations were undertaken to determine the progression of VD. Independent predictors of valvular progression were identified by Cox regression analysis.</p><p><strong>Results: </strong>A total of 77 patients were recruited, 36 (46.7%) of whom were male, and the median age (range) was 12.3 years (5.9-17.8). Thirty-three (42.8%) had progression of VD in the year after diagnosis. By multivariable analysis, an age at diagnosis of >10 years and high C-reactive protein (CRP) were independently associated with an increased risk of valvular progression with an adjusted hazard ratio (95% CI) of 3.23 (1.09-9.60) and 3.69 (1.45-9.67), respectively.</p><p><strong>Conclusion: </strong>After only 1 year of follow-up, approximately four in 10 children with newly diagnosed RHD developed progression of VD. An increased risk of valvular progression was associated with being over 10 years of age and a high level of CRP.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39850189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1080/20469047.2021.2023436
J. Nöthling, B. Laughton, S. Seedat
ABSTRACT Background In low- and middle-income countries, there is a high prevalence of post-partum depression and it is often associated with HIV status. Maternal depression negatively affects mothering and can lead to social withdrawal in infants. Maternal depression and infant social withdrawal can have deleterious long-term effects on children’s behaviour and neurodevelopmental trajectories. Aim To investigate whether maternal depression and infant social withdrawal at 10–12 months post-partum were significant predictors of child behaviour and development at 42 months. Method Seventy-four mother–infant dyads living with HIV were followed in a prospective, longitudinal design. Mothers were assessed for depression using the Center for Epidemiologic Studies Depression scale (CES-D). Infant social withdrawal was assessed by the modified Alarm Distress Baby Scale (m-ADBB), and development and behaviour were evaluated by the Griffiths Mental Development Scales (GMDS) and the Child Behavior Checklist (CBCL), respectively. Results Maternal depression explained 4.8% of the variance in child behaviour (β = 0.98, t = 2.05, p < 0.05) and 10.3% of the variance in development (β = −0.30, t = −2.66, p < 0.05). Infant social withdrawal was not a significant predictor of behaviour (β = 3.27, t = 1.36, p = 0.18), but it did uniquely explain 7% of the variance in development (β = −1.32, t = −2.48, p < 0.05). Conclusion In the context of HIV, screening for maternal depression and the quality of mother–infant interactions are important (especially in the 1st year post-partum), given the significant long-term impact they have on behaviour and neurodevelopment. Abbreviations ANOVA: analysis of variance; ART: antiretroviral therapy; CBCL: Child Behavioral Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; CHEI: children HIV-exposed and infected; CHER: Children with HIV Early Antiretroviral Treatment Trial; CHEU: children HIV-exposed and uninfected; CHUU: children HIV-unexposed and -uninfected; GMDS: Griffiths Mental Development Scales; HIV: human immunodeficiency virus; LMIC: low- and middle-income countries; m-ADBB: modified Alarm Distress Baby Scale; NRF: National Research Foundation; SAMRC: South African Medical Research Council; WHO: World Health Organization
{"title":"Maternal depression and infant social withdrawal as predictors of behaviour and development in vertically HIV-infected children at 3.5 years","authors":"J. Nöthling, B. Laughton, S. Seedat","doi":"10.1080/20469047.2021.2023436","DOIUrl":"https://doi.org/10.1080/20469047.2021.2023436","url":null,"abstract":"ABSTRACT Background In low- and middle-income countries, there is a high prevalence of post-partum depression and it is often associated with HIV status. Maternal depression negatively affects mothering and can lead to social withdrawal in infants. Maternal depression and infant social withdrawal can have deleterious long-term effects on children’s behaviour and neurodevelopmental trajectories. Aim To investigate whether maternal depression and infant social withdrawal at 10–12 months post-partum were significant predictors of child behaviour and development at 42 months. Method Seventy-four mother–infant dyads living with HIV were followed in a prospective, longitudinal design. Mothers were assessed for depression using the Center for Epidemiologic Studies Depression scale (CES-D). Infant social withdrawal was assessed by the modified Alarm Distress Baby Scale (m-ADBB), and development and behaviour were evaluated by the Griffiths Mental Development Scales (GMDS) and the Child Behavior Checklist (CBCL), respectively. Results Maternal depression explained 4.8% of the variance in child behaviour (β = 0.98, t = 2.05, p < 0.05) and 10.3% of the variance in development (β = −0.30, t = −2.66, p < 0.05). Infant social withdrawal was not a significant predictor of behaviour (β = 3.27, t = 1.36, p = 0.18), but it did uniquely explain 7% of the variance in development (β = −1.32, t = −2.48, p < 0.05). Conclusion In the context of HIV, screening for maternal depression and the quality of mother–infant interactions are important (especially in the 1st year post-partum), given the significant long-term impact they have on behaviour and neurodevelopment. Abbreviations ANOVA: analysis of variance; ART: antiretroviral therapy; CBCL: Child Behavioral Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; CHEI: children HIV-exposed and infected; CHER: Children with HIV Early Antiretroviral Treatment Trial; CHEU: children HIV-exposed and uninfected; CHUU: children HIV-unexposed and -uninfected; GMDS: Griffiths Mental Development Scales; HIV: human immunodeficiency virus; LMIC: low- and middle-income countries; m-ADBB: modified Alarm Distress Baby Scale; NRF: National Research Foundation; SAMRC: South African Medical Research Council; WHO: World Health Organization","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44388009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01Epub Date: 2021-03-14DOI: 10.1080/20469047.2021.1883960
Tülay İnce Becerir, Ayça Altincik, Bayram Özhan, Selçuk Yüksel
Subcutaneous fat necrosis (SFN) in the newborn is a form of panniculitis which presents with erythematous nodules and indurated plaques. Severe life-threatening hypercalcaemia can occur as a late complication. A 2-month-old girl presented with severe hypercalcaemia and acute renal injury as a complication of SFN. She was admitted to hospital with the chief complaint of failure to thrive. She had a history of therapeutic hypothermia. After successful treatment of the hypercalcaemia with bisphosphonates, the acute renal injury recovered spontaneously. In neonates with SFN, acute renal injury is a rare complication of hypercalcaemia. Timely prevention of the complications of hypercalcaemia in SFN is essential.
{"title":"Severe hypercalcaemia and acute renal failure in an infant with subcutaneous fat necrosis.","authors":"Tülay İnce Becerir, Ayça Altincik, Bayram Özhan, Selçuk Yüksel","doi":"10.1080/20469047.2021.1883960","DOIUrl":"https://doi.org/10.1080/20469047.2021.1883960","url":null,"abstract":"<p><p>Subcutaneous fat necrosis (SFN) in the newborn is a form of panniculitis which presents with erythematous nodules and indurated plaques. Severe life-threatening hypercalcaemia can occur as a late complication. A 2-month-old girl presented with severe hypercalcaemia and acute renal injury as a complication of SFN. She was admitted to hospital with the chief complaint of failure to thrive. She had a history of therapeutic hypothermia. After successful treatment of the hypercalcaemia with bisphosphonates, the acute renal injury recovered spontaneously. In neonates with SFN, acute renal injury is a rare complication of hypercalcaemia. Timely prevention of the complications of hypercalcaemia in SFN is essential.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1883960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25474113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01Epub Date: 2021-09-08DOI: 10.1080/20469047.2021.1967627
Bryan J Vonasek, Susan Mhango, Heather L Crouse, Temwachi Nyangulu, Wilfred Gaven, Emily Ciccone, Alexander Kondwani, Binita Patel, Elizabeth Fitzgerald
Background: Severe acute malnutrition (SAM) is common in low-income countries and is associated with high mortality in young children.
Objective: To improve recognition and management of SAM in a tertiary hospital in Malawi.
Methods: The impact of multifaceted quality improvement interventions in process measures pertaining to the identification and management of SAM was assessed. Interventions included focused training for clinical staff, reporting process measures to staff, and mobile phone-based group messaging for enhanced communication. This initiative focused on children aged 6-36 months admitted to Kamuzu Central Hospital in Malawi from September 2019 to March 2020. Before-after comparisons were made with baseline data from the year before, and process measures within this intervention period which included three plan-do-study-act (PDSA) cycles were compared.
Results: During the intervention period, 418 children had SAM and in-hospital mortality was 10.8%, which was not significantly different from the baseline period. Compared with the baseline period, there was significant improvement in the documentation of full anthropometrics on admission, blood glucose test within 24 hours of admission and HIV testing results by discharge. During the intervention period, amidst increasing patient census with each PDSA cycle, three process measures were maintained (documentation of full anthropometrics, determination of nutritional status and HIV testing results), and there was significant improvement in blood glucose documentation.
Conclusion: Significant improvement in key quality measures represents early progress towards the larger goal of improving patient outcomes, most notably mortality, in children admitted with SAM.
{"title":"Improving recognition and management of children with complicated severe acute malnutrition at a tertiary referral hospital in Malawi: a quality improvement initiative.","authors":"Bryan J Vonasek, Susan Mhango, Heather L Crouse, Temwachi Nyangulu, Wilfred Gaven, Emily Ciccone, Alexander Kondwani, Binita Patel, Elizabeth Fitzgerald","doi":"10.1080/20469047.2021.1967627","DOIUrl":"https://doi.org/10.1080/20469047.2021.1967627","url":null,"abstract":"<p><strong>Background: </strong>Severe acute malnutrition (SAM) is common in low-income countries and is associated with high mortality in young children.</p><p><strong>Objective: </strong>To improve recognition and management of SAM in a tertiary hospital in Malawi.</p><p><strong>Methods: </strong>The impact of multifaceted quality improvement interventions in process measures pertaining to the identification and management of SAM was assessed. Interventions included focused training for clinical staff, reporting process measures to staff, and mobile phone-based group messaging for enhanced communication. This initiative focused on children aged 6-36 months admitted to Kamuzu Central Hospital in Malawi from September 2019 to March 2020. Before-after comparisons were made with baseline data from the year before, and process measures within this intervention period which included three plan-do-study-act (PDSA) cycles were compared.</p><p><strong>Results: </strong>During the intervention period, 418 children had SAM and in-hospital mortality was 10.8%, which was not significantly different from the baseline period. Compared with the baseline period, there was significant improvement in the documentation of full anthropometrics on admission, blood glucose test within 24 hours of admission and HIV testing results by discharge. During the intervention period, amidst increasing patient census with each PDSA cycle, three process measures were maintained (documentation of full anthropometrics, determination of nutritional status and HIV testing results), and there was significant improvement in blood glucose documentation.</p><p><strong>Conclusion: </strong>Significant improvement in key quality measures represents early progress towards the larger goal of improving patient outcomes, most notably mortality, in children admitted with SAM.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671256/pdf/nihms-1736428.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39411897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infants may develop congenital tuberculosis from an infectious mother or acquire the disease postnatally by contact with an infectious adult. Delayed diagnosis is common, especially in infants under 1 year of age, and, if unrecognised, there is an increased risk of death. A 2.5-month-old boy presented with respiratory distress, small inhomogeneous opacities in both lungs and hepatosplenomegaly mimicking sepsis. He had received BCG vaccination and there was no history of contact with tuberculosis (TB). He had had fever since 1 month of age for which there had been several outpatient visits. Gastric aspirate cartridge-based nucleic acid amplification test (CBNAAT) confirmed TB and sonological evaluation demonstrated multiple granulomata in the liver and spleen, and a liver biopsy supported TB. He responded well to 12 months of anti-tuberculous treatment. The mother's tuberculin test, chest radiograph and endometrial biopsy showed no evidence of TB. There was no history of tuberculous contact with close family members. Despite the lack of proof of current tuberculous TB infection in the mother, it is likely that the infant had congenital TB.
{"title":"Tuberculosis in a 2.5-month-old infant: congenital or acquired dilemma?","authors":"Yellanthoor Ramesh Bhat, Sandesh Kini, Lakshmikanth Halegubbi Karegowda","doi":"10.1080/20469047.2020.1848270","DOIUrl":"https://doi.org/10.1080/20469047.2020.1848270","url":null,"abstract":"<p><p>Infants may develop congenital tuberculosis from an infectious mother or acquire the disease postnatally by contact with an infectious adult. Delayed diagnosis is common, especially in infants under 1 year of age, and, if unrecognised, there is an increased risk of death. A 2.5-month-old boy presented with respiratory distress, small inhomogeneous opacities in both lungs and hepatosplenomegaly mimicking sepsis. He had received BCG vaccination and there was no history of contact with tuberculosis (TB). He had had fever since 1 month of age for which there had been several outpatient visits. Gastric aspirate cartridge-based nucleic acid amplification test (CBNAAT) confirmed TB and sonological evaluation demonstrated multiple granulomata in the liver and spleen, and a liver biopsy supported TB. He responded well to 12 months of anti-tuberculous treatment. The mother's tuberculin test, chest radiograph and endometrial biopsy showed no evidence of TB. There was no history of tuberculous contact with close family members. Despite the lack of proof of current tuberculous TB infection in the mother, it is likely that the infant had congenital TB.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1848270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38715463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01Epub Date: 2021-07-06DOI: 10.1080/20469047.2021.1946651
Emine Polat, Saliha Senel
An overdose of isoniazid (INH) is potentially fatal and attempts at suicide are very rare in children. Three patients aged 14-17 years who were receiving INH for tuberculosis prophylaxis were admitted to the emergency department with generalised tonic-clonic seizures. There was metabolic acidosis and elevated levels of blood creatine kinase, aminotransferases and lactate dehydrogenase following ingestion of excess INH in attempts at suicide. The presumed total amounts of INH ingested were 3 g (40 mg/kg), 9 g (160 mg/kg) and 6 g (100 mg/kg), respectively. They all improved with general supportive measures including airway protection, gastric lavage, activated charcoal administration, sodium bicarbonate infusion, fluid replacement, seizure control and pyridoxine administration. They were discharged without complications. Attempts to commit suicide by excess intake of INH is rare in children but should be considered in the differential diagnosis of acute intractable seizures and metabolic acidosis refractory to conventional anticonvulsant therapy in adolescents.
过量服用异烟肼(INH)有潜在的致命危险,儿童很少有自杀企图。3名14-17岁接受INH治疗以预防结核病的患者因全身性强直-阵挛性发作而被送至急诊科。有代谢性酸中毒和血肌酸激酶,转氨酶和乳酸脱氢酶的水平升高后摄入过量的INH企图自杀。推测摄取的INH总量分别为3 g (40 mg/kg)、9 g (160 mg/kg)和6 g (100 mg/kg)。采用常规支持措施,包括气道保护、洗胃、活性炭、碳酸氢钠输注、液体补充、癫痫控制和吡哆醇等,均有改善。他们均无并发症出院。过量摄入INH自杀的企图在儿童中很少见,但在鉴别诊断青少年急性难治性癫痫发作和代谢性酸中毒时应予以考虑。
{"title":"Suicide attempt with isoniazid in adolescents receiving tuberculous prophylaxis: three cases.","authors":"Emine Polat, Saliha Senel","doi":"10.1080/20469047.2021.1946651","DOIUrl":"https://doi.org/10.1080/20469047.2021.1946651","url":null,"abstract":"<p><p>An overdose of isoniazid (INH) is potentially fatal and attempts at suicide are very rare in children. Three patients aged 14-17 years who were receiving INH for tuberculosis prophylaxis were admitted to the emergency department with generalised tonic-clonic seizures. There was metabolic acidosis and elevated levels of blood creatine kinase, aminotransferases and lactate dehydrogenase following ingestion of excess INH in attempts at suicide. The presumed total amounts of INH ingested were 3 g (40 mg/kg), 9 g (160 mg/kg) and 6 g (100 mg/kg), respectively. They all improved with general supportive measures including airway protection, gastric lavage, activated charcoal administration, sodium bicarbonate infusion, fluid replacement, seizure control and pyridoxine administration. They were discharged without complications. Attempts to commit suicide by excess intake of INH is rare in children but should be considered in the differential diagnosis of acute intractable seizures and metabolic acidosis refractory to conventional anticonvulsant therapy in adolescents.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1946651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39155489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01Epub Date: 2020-10-12DOI: 10.1080/20469047.2020.1826780
Gabriele Baniulyte, Sima Svirpliene, Andrew Eccleston, Sangeetha Arjunan, Martin Connor
Neisseria oralis is a bacterium which normally resides within the oral microflora. A female infant was born by emergency caesarean section owing to fetal distress with a gestational age of 38 weeks, a birthweight of 2250 g and a temperature of 36.5°C. The pregnancy had been normal. The delivery was complicated by prolonged rupture of membranes (48 hours) and meconium-stained and foul-smelling liquor. APGAR scores were 1 at 1 min, 9 at 5 min and 9 at 10 min. The infant looked pale and had respiratory distress requiring resuscitation for the first 4 minutes. After a septic screen, she was commenced on benzylpenicillin and gentamicin. On Day 1 of life she was diagnosed with neonatal sepsis, and N. oralis was identified in blood cultures and blood-stained cerebrospinal fluid (CSF). Although N. oralis was cultured from the CSF, it was considered that this was more likely owing to blood contamination of the CSF. In view of the blood and CSF cultures, antibiotics were changed to intravenous cefotaxime. By Day 6 blood infection markers were regarded as normal. Antibiotics were continued for 14 days. Although neonatal sepsis caused by N. oralis has not been reported before, it should be considered to be a pathogen able to cause neonatal sepsis.
{"title":"<i>Neisseria oralis</i> septicaemia in a newborn: first recorded case.","authors":"Gabriele Baniulyte, Sima Svirpliene, Andrew Eccleston, Sangeetha Arjunan, Martin Connor","doi":"10.1080/20469047.2020.1826780","DOIUrl":"https://doi.org/10.1080/20469047.2020.1826780","url":null,"abstract":"<p><p><i>Neisseria oralis</i> is a bacterium which normally resides within the oral microflora. A female infant was born by emergency caesarean section owing to fetal distress with a gestational age of 38 weeks, a birthweight of 2250 g and a temperature of 36.5°C. The pregnancy had been normal. The delivery was complicated by prolonged rupture of membranes (48 hours) and meconium-stained and foul-smelling liquor. APGAR scores were 1 at 1 min, 9 at 5 min and 9 at 10 min. The infant looked pale and had respiratory distress requiring resuscitation for the first 4 minutes. After a septic screen, she was commenced on benzylpenicillin and gentamicin. On Day 1 of life she was diagnosed with neonatal sepsis, and <i>N. oralis</i> was identified in blood cultures and blood-stained cerebrospinal fluid (CSF). Although <i>N. oralis</i> was cultured from the CSF, it was considered that this was more likely owing to blood contamination of the CSF. In view of the blood and CSF cultures, antibiotics were changed to intravenous cefotaxime. By Day 6 blood infection markers were regarded as normal. Antibiotics were continued for 14 days. Although neonatal sepsis caused by <i>N. oralis</i> has not been reported before, it should be considered to be a pathogen able to cause neonatal sepsis.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1826780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38477931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}