Annals of Tropical Paediatrics最新文献

Cushing syndrome developed in two children following inappropriate dosage and duration of corticosteroids by parents. One was a 7-year-old boy who was prescribed prednisolone for treatment of neurocysticercosis. The other was a 1-year-old boy who was prescribed oral betamethasone for a respiratory infection.

Background: As the signs of dehydration often overlap with those of pneumonia, it may be difficult for health workers in resource-poor settings to make a clinical diagnosis of pneumonia in children with dehydration. This issue has received very little attention.

Aim: To compare the clinical features of pneumonia in children with and without dehydration caused by diarrhoea.

Methods: All children aged 2-59 months with diarrhoea and radiologically confirmed pneumonia admitted to the Special Care Ward (SCW) of Dhaka Hospital, ICDDR,B between September and December 2007 were enrolled for the study. Children with dehydration (67 cases) and those without (101 controls) were compared.

Results: Cases presented less frequently with fast breathing (60% vs 88%, p<0.001) and lower chest-wall indrawing (67% vs 82%, p=0.035) than did controls. In logistic regression analysis, cases more often had severe malnutrition (OR 2.31, CI 1.06-5.02, p=0.035) and cyanosis (OR 19.05, CI 1.94-186.68, p=0.011) and were abnormally sleepy (OR 372, CI 1.71-8.08, p=0.001).

Conclusions: Fast breathing and lower chest-wall indrawing may be less reliable for the diagnosis of pneumonia in children with dehydration, especially when there is severe malnutrition.

Background: With 80% of children with disabilities living in resource-poor settings, it is likely that there is a high prevalence of cerebral palsy (CP) and neurological impairment in these settings. The prevalence and incidence rates of disability, in particular of children with CP in resource-poor settings, are difficult to access and clarify.

Aim: To review the recent literature relating to the prevalence, incidence, type and aetiology of cerebral palsy in low-income settings.

Methods: A systematic search of studies published between 1990 and 2009 was performed using PubMed, Cinahl on Ovid, the Cochrane database, SCOPUS and information from international disability organisations. All studies with information about neurodisability, CP or disability in resource-poor settings were included. Titles and/or abstracts of all studies were reviewed and full texts of relevant studies were obtained.

Results: Disparities in methodology, age range, classification systems and populations made studies difficult to compare. Population-based studies provided rates of childhood disability of 31-160/1000. When using limited age ranges of 2-9 years with the Ten Question Questionnaire, rates were 82-160/1000 for children disability and 19-61/1000 for neurological impairment. Rates of CP in population-based settings in China and India gave figures of 2-2.8/1000 births, similar to western settings. Hospital-based studies of CP showed increased rates of spastic quadriplegia rather than diplegia or hemiplegia and possibly increased rates of meningitis, jaundice and asphyxia and lower rates of low birthweight and prematurity in CP populations. These studies were small and not case-controlled or population-based.

Conclusions: Rates of CP and neurological impairment are difficult to obtain in resource-poor settings. Methods of identifying children with CP and causal factors and the effects of disability need to be better classified in order to improve management and help shape preventive measures.

Background: Pubertal delay can be a manifestation of a wide variety of diseases, the proportions of which may vary between developing and industrialised countries.

Objective: A retrospective study was undertaken to investigate the aetiology of delayed puberty in northern India.

Subjects and methods: Follow-up records of patients with delayed puberty presenting to the endocrine clinic between 2003 and 2007 were analysed.

Results: Forty-two patients (19 boys, 23 girls, age range 14-27 y) of 46 who initially presented had complete evaluation. The main causes of pubertal delay were chronic systemic illnesses (16), e.g. malnutrition, anaemia and chronic infections, hormone deficiencies (11), hypergonadotrophic hypogonadism (7) and constitutional delay (6). While the majority of girls (11/23) were found to have underlying systemic disorders, endocrinopathies (6/19) were the major causes of pubertal delay in boys.

Conclusion: Chronic systemic illnesses are the major cause of pubertal delay in developing countries. Social awareness and education leading to early detection and treatment can prevent pubertal delay in a large proportion of cases.

Background: Evidence of hepatocellular damage is common in dengue-infected individuals. Hepatocyte growth factor (HGF), a key cytokine responsible for liver regeneration, may play a prognostic role in dengue virus infection.

Aim: To determine the relationship between serum HGF level and disease severity in patients with dengue virus infection.

Methods: Serum samples from 27 children [17 dengue fever (DF), ten dengue haemorrhagic fever (DHF)] with serologically confirmed dengue virus infection during the febrile, toxic stages and at follow-up were analysed for HGF. Serum samples obtained from nine healthy children served as the control group.

Results: In dengue-infected patients, serum HGF was significantly higher at the febrile and toxic stages than at follow-up (p<0.05). In comparison with DF, patients with DHF had a greater level of HGF at the febrile stage (p<0.05). A cut-off HGF level of 1220 pg/mL obtained during the febrile stage showed a sensitivity of 90% and a specificity of 53% for predicting clinical progression to DHF (area under the ROC curve 0.75).

Conclusion: Serum HGF level at the early stage of dengue virus infection is elevated and may be a useful predictor for clinical progression to DHF.

Aims: To compare the effects on time of umbilical cord separation of cleaning with 95% alcohol and natural drying in a high-humidity subtropical country.

Methods: One hundred and fifty neonates were randomly assigned to two groups, 75 in each. For the control group, umbilical cleansing with 95% alcohol was performed after daily bathing; natural drying without a topical regimen was used for the trial group.

Results: Complete information was obtained for 71 neonates in the control group and 71 in the trial group. At 1 month after delivery, no enrolled neonate had developed omphalitis or skin infection. Cord separation time was significantly reduced for the natural-drying group compared with the alcohol-cleansing group (p=0.014). In both groups, separation time was longer for newborns delivered by caesarean section than for those delivered vaginally (p=0.001). Nine mothers in the trial group and five in the control group complained of discharge from the umbilicus. Separation time was not influenced by gender, gestational age, birthweight or length, gravidity, meconium staining, maternal age or presence of discharge.

Conclusions: Cleaning with 95% alcohol did not reduce umbilical cord separation time. This traditional method is not necessary for routine cord management, even in a subtropical country.

A 6-hour-old infant was admitted with severe respiratory distress and hepatosplenomegaly. Her mother had arthralgia for 4 weeks in the 7/8th month of pregnancy and the infant was born at 31 weeks. Brucella spp was detected in blood culture and serology in mother and infant, supporting the diagnosis of brucellosis with presumed transplacental transmission.

A child with anterior uveitis as the sole manifestation of group A streptococcal infection is described. There was a history of a 'viral' upper respiratory tract infection 2 weeks before the onset of uveitis. A post-streptococcal phenomenon was diagnosed on the basis of serial ASO titre (ASOT) monitoring. There are few reports of patients with post-streptococcal uveitis. ASOT monitoring should be included in the work-up of uveitis of undetermined aetiology.

Background: Each year, malaria threatens 125 million pregnancies, and gestational malaria is responsible for up to 200,000 infant deaths in sub-Saharan Africa. With advancing knowledge of malaria in pregnancy and its impact on newborns, improved preventive and therapeutic interventions are possible.

Methods: We reviewed and, by consensus, evaluated published literature relevant to malaria and newborns. Important findings are summarised.

Results: Pregnant women are more likely than others to be inoculated with and infected by malaria parasites. Poor outcomes are particularly common in primigravid women and their offspring. The placenta is affected through cellular adhesion, cytokine production and mononuclear cell infiltrates. As a result, newborns may have low birthweight owing to intrauterine growth retardation or prematurity. Recent evidence suggests that a subset of these infants is also at higher risk of malaria infections later in life. Preventive strategies to improve maternal and fetal outcomes include intermittent preventive treatment and insecticide-treated bed nets. Asymptomatic malaria infection is not uncommon in newborns, and symptomatic disease occurs. Fever and death are possible during the early days of life, and presentation with a sepsis-like illness can occur during the 1st 2 months of life. Malaria-affected infants face higher than usual risks of infantile anaemia, subsequent malaria infection and death during the 1st year of life.

Conclusions: Malaria is common during pregnancy and can have serious consequences for neonatal health. Neonatal morbidity and mortality can be significantly reduced by proper implementation of insecticide-treated nets and intermittent preventive treatment.

Emergency care has been neglected in many resource-constrained countries and yet 50% of paediatric admissions die in the 1st 24 hours of admission. Carers may know how to manage clinical problems but there might not be a system in place to provide timely and appropriate care. This article reviews the needs--staffing, materials and physical layout--of a receiving hospital unit and describes how to set up a system of patient flow and care that prioritises and provides timely care, so that when a patient arrives in hospital the system does not fail them.