Annals of Tropical Paediatrics最新文献

Persistent umbilical drainage may be due to vestigial remnants of the omphalomesenteric duct. Rarely, it may be owing to the presence of ectopic pancreatic tissue within these remnants. An 18-month-old boy underwent surgical exploration for umbilical discharge. An umbilical nodule containing both ectopic gastric and pancreatic tissue was found. This is the first instance where both tissue types have been implicated as a cause.

A term neonate was born to a mother who had consumed an organophosphorus compound with suicidal intent 50 hours before delivery. At birth, the infant showed signs and symptoms of organophosphorus poisoning and was treated with atropine and pralidoxime to which she responded well. Unfortunately, the mother died despite appropriate treatment. This is only the second report documenting transplacental organophosphate poisoning.

Aim: To report diagnostic, clinical and therapeutic aspects of cyanide intoxication resulting from ingestion of cyanogenic glucoside-containing apricot seeds.

Methods: Thirteen patients admitted to the Pediatric Intensive Care Unit (PICU) of Erciyes University between 2005 and 2009 with cyanide intoxication associated with ingestion of apricot seeds were reviewed retrospectively.

Results: Of the 13 patients, four were male. The mean time of onset of symptoms was 60 minutes (range 20 minutes to 3 hours). On admission, all patients underwent gastric lavage and received activated charcoal. In addition to signs of mild poisoning related to cyanide intoxication, there was severe intoxication requiring mechanical ventilation (in four cases), hypotension (in two), coma (in two) and convulsions (in one). Metabolic acidosis (lactic acidosis) was detected in nine patients and these were treated with sodium bicarbonate. Hyperglycaemia occurred in nine patients and blood glucose levels normalised spontaneously in six but three required insulin therapy for 3-6 hours. Six patients received antidote treatment: high-dose hydroxocobalamin in four and two were treated with a cyanide antidote kit in addition to high-dose hydroxocobalamin. One patient required anticonvulsive therapy. All patients recovered and were discharged from the PICU within a mean (SD, range) 3.1 (1.7, 2-6) days.

Conclusion: Cyanide poisoning associated with ingestion of apricot seeds is an important poison in children, many of whom require intensive care.

Background: The role of coronaviruses in paediatric gastro-enteritis is not well defined. We investigated the detection rate and epidemiological features of infection with coronavirus in children receiving hospital care for acute gastro-enteritis in Maddina, Saudi Arabia.

Methods: Stool specimens were collected from children less than 5 years of age who were either hospitalised in Maddina or given oral rehydration therapy as outpatients between April 2004 and April 2005. Coronaviruses were detected by electron microscopy.

Results: Coronaviruses were detected in 63 (6%) of 984 children with acute gastro-enteritis and were more commonly detected in outpatients (47/423, 11%) than in inpatients (16/561, 3%). The median age (range) of children with coronavirus infection was 42 months (10-60). Coronaviruses were detected throughout the year with the highest detection rate at the end of the winter season.

Conclusions: Coronaviruses were commonly identified in children with diarrhoea in Saudi Arabia. Their role in paediatric gastro-enteritis warrants further evaluation.

Systemic reactions to contact with a caterpillar are rare in children. A 3-month-old infant presented to the emergency department with acute onset of rash, severe respiratory distress and shock. Her mother volunteered that the infant had been exposed to a tree processionary caterpillar. The infant responded to systemic corticosteroids and antihistamines although the rash persisted for more than 5 days.

Aims: To explore the role of a traditional illness of the newborn, asram, in care-seeking in rural Ghana.

Methods: Data are from formative research into newborn care which included collecting qualitative data from 14 villages in Brong Ahafo region of Ghana through 25 birth narratives, 30 in-depth interviews and two focus groups with recently delivered/pregnant women, 20 in-depth interviews and six focus groups with birth attendants/grandmothers, 12 in-depth interviews and two focus groups with husbands, and six in-depth interviews with asram healers.

Results: The study confirmed that asram is characterised by symptoms which include green/black veins, a big head and the newborn growing lean. However, a complex classification of 14 types of asram covering a wide array of symptoms was identified. Asram was perceived as a common illness which cannot be treated at health facilities and to which many danger signs in the newborn are attributed, and thus it affects care-seeking. Asram treatment includes frequent cold herbal baths and air-drying; however, oral treatments and preventive bathing are also used. Any modification of asram treatment was reported to require the sanction of a healer.

Conclusion: Understanding traditional illnesses as a potential barrier to newborn care-seeking is essential for designing care-seeking interventions. An asram diagnosis can prevent sick newborns being taken to health facilities and traditional treatment exposes them to the risk of hypothermia.

Hypoxaemia is a common problem causing child deaths in developing countries, but the cost-effective ways to address hypoxaemia are ignored by current global strategies. Improving oxygen supplies and the detection of hypoxaemia has been shown to reduce death rates from childhood pneumonia by up to 35%, and to be cheaper per life saved than other effective initiatives such as conjugate pneumococcal vaccines. Oxygen concentrators provide the cheapest and most consistent source of oxygen in health facilities where power supplies are reliable. To implement and sustain oxygen concentrators requires strengthening of health systems, with clinicians, teachers, administrators and technicians working together. Programmes built around the use of pulse oximetry and oxygen concentrators are an entry point for improving quality of care, and are a unique example of successful integration of appropriate technology into clinical care. This paper is a practical and up-to-date guide for all involved in purchasing, using and maintaining oxygen concentrators in developing countries.

Objectives: The effectiveness of skin-to-skin contact to decrease pain from heel-lancing in healthy term neonates and whether breastfeeding in addition to skin-to-skin contact provided a more effective analgesia than skin-to-skin contact alone were investigated.

Methods: A randomised, controlled trial was conducted in 107 neonates undergoing heel-lance. Infants were randomly assigned to three groups: (i) being breastfed with skin-to-skin contact (group 1, n=35), (ii) being held in their mother's arms with skin-to-skin contact but no breastfeeding (group 2, n=36), or (iii) lying on the table before, during and after painful stimulus (group 3, n=36). Physiological responses to pain were measured by heart rate and oxygen saturation changes and behavioural responses were measured by duration of crying and grimacing.

Results: Infants had a mean (SD) birthweight of 3355 (270) g and gestational age of 39.5 (0.6) weeks; at the time of the procedure, mean (SD) postnatal age was 33.1 (5) hours. There was no significant difference between the groups in clinical characteristics and time spent squeezing the heel. Heart rate, oxygen saturation changes and length of crying were significantly reduced in groups 1 and 2 compared with group 3 (p<0.001). No difference was found between group 1 and group 2. Grimacing was less in group 2 than in group 3 (p<0.001).

Conclusions: In healthy term neonates, skin-to-skin contact with the mother and breastfeeding with skin-to-skin contact reduce both physiological and behavioural pain response. Breastfeeding in the 1st 2 postnatal days with skin-to-skin contact did not increase the analgesic effect of skin-to-skin contact alone.

Anthropometry is a useful tool, both for monitoring growth and for nutritional assessment. The publication by WHO of internationally agreed growth standards in 1983 facilitated comparative nutritional assessment and the grading of childhood malnutrition. New growth standards for children under 5 years and growth reference for children aged 5-19 years have recently (2006 and 2007) been published by WHO. Growth of children <5 years was recorded in a multi-centre growth reference study involving children from six countries, selected for optimal child-rearing practices (breastfeeding, non-smoking mothers). They therefore constitute a growth standard. Growth data for older children were drawn from existing US studies, and upward skewing was avoided by excluding overweight subjects. These constitute a reference. More indicators are now included to describe optimal early childhood growth and development, e.g. BMI for age and MUAC for age. The growth reference for older children (2007) focuses on linear growth and BMI; weight-for-age data are age-limited and weight-for-height is omitted. Differences in the 2006 growth pattern from the previous reference for children <5 are attributed to differences in infant feeding. The 2006 'reference infant' is at first heavier and taller than his/her 1983 counterpart, but is then lighter until the age of 5. Being taller in the 2nd year, he/she is less bulky (lighter for height) than the 1983 reference toddler. The spread of values for height and weight for height is narrower in the 2006 dataset, such that the lower limit of the normal range for both indices is set higher than in the previous dataset. This means that a child will be identified as moderately or severely underweight for height (severe acute malnutrition) at a greater weight for height than previously. The implications for services for malnourished children have been recognised and strategies devised. The emphasis on BMI-for-age as the indicator for thinness and obesity in older children is discussed. The complexity of calculations for health cadres without mathematical backgrounds or access to calculation software is also an issue. It is possible that the required charts and tables may not be accessible to those working in traditional health/nutrition services which are often poorly equipped.