Pediatric health, medicine and therapeutics最新文献

Background: Around 15 million live newborns are born prematurely each year around the world before 37 weeks. One cause of inadequate nursing is prematurity. The goal of this study was to find parameters linked to an insufficient volume of expressed milk among mothers of preterm and low birth weight neonates at government hospitals in Addis Ababa, Ethiopia.

Methods: An nstitution-based cross-sectional study was conducted on a total of 124 mothers who were available in neonatal intensive care units during the study period in government hospitals that provided such units.

Results: One-third of the responders (33.9%) were unable to express the necessary amount of milk. An inadequate volume of expressed breast milk was significantly associated with a baby's stable health status (AOR=0.24; CI=0.07-0.86), the fair (subcritical) health status of the baby (AOR=0.178; CI=0.04-0.76), worry about the volume of milk (AOR=7.50; CI=3.32-16.95), and worry about the baby's health status (AOR=4.63; CI=2.21-9.70).

Conclusion: According to our findings, 33.9% of mothers were unable to express sufficient amounts of milk. To produce an adequate volume of expressed breast milk, health care workers must address mothers' psychological issues in the neonatal intensive care units and give all necessary care to prevent neonatal deterioration.

Background: Providing food to the school children is an important means of compacting malnutrition especially in high food insecure areas. Our study was conducted to evaluate the association between school feeding and nutritional status among students in primary schools of Dubti district in Afar region.

Methods: A comparative cross-sectional study was employed on 936 primary school students from March 15-31/2021. For data collection, structured questionnaire was administered by the interviewer. Descriptive statistics as well as logistic regression was conducted. WHO Anthro-plus software was used to compute anthropometric data. Adjusted odds ratio with 95% CI was calculated to identify the level of association. Variables with p-value <0.05 were taken as statistical level of significance.

Results: A total of 936 primary school students, with 100% response rate, were included in the current study. The prevalence of stunting in school fed and non-school fed students was 13.7% 95% CI (11, 17) and 21.6% 95% CI (18, 25), respectively. The prevalence of thinness in school fed and non-school fed students was 4.9% 95% CI (3, 7) and 13.9% 95% CI (11, 17), respectively. Even though no record of overweight and obesity were found in non-school fed students, 5.4% 95% CI (3, 7) among school fed students was overweight/obese. Grade level, diet information source, media source availability, maternal age, the critical time for hand washing, and nutrition education were found to be predictors of malnutrition in both groups of students.

Conclusion: The magnitude of stunting and thinness in school fed students is found to be lower, but overnutrition is higher than non-school fed. Grade level of students and diet selection information were determinants that affected the nutritional status of students. Coordinated education regarding good feeding practice, and personal as well as environmental hygiene should be given to the students and their families.

Sternal cleft is a rare chest wall anomaly resulting from a failure of the lateral mesodermal folds to migrate to the midline, causing a cleft in the early stage of embryological development. This can be a complete or partial defect. It can also occur as an isolated anomaly or in association with other syndromes. Fetal sonographic diagnosis of this defect is possible, but less practiced. After birth, this defect can be easily diagnosed clinically because of the presence of paradoxical chest wall movement. The flexibility of the thorax is maximal and compression of the underlying structures is minimal during the neonatal and early infancy period, and this period is the preferred time for surgical repair. We report a 39-day-old infant who presented with an isolated V-shaped inferior sternal cleft, its surgical primary closure, and postoperative course.

Background: Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia.

Methods: A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality.

Results: The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009].

Conclusion: There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.

The coronavirus disease (COVID-19) pandemic affected the management and follow-up of several chronic ailments, including pediatric type 1 diabetes mellitus (T1DM). Restricted access to healthcare and fear of contracting the virus during medical facility visits resulted in poor compliance, irregular follow-up visits, treatment, and delayed diagnosis of complications in pediatric diabetes such as diabetic ketoacidosis (DKA). As such, the incidence of complicated DKA in resource-limited settings is high due to delayed presentation, poor compliance with therapy, and associated comorbidities such as malnutrition and sepsis. The pandemic had only added to the woes. The increased surge in DKA, in the face of limited resources, prompted clinicians to find alternative solutions to manage these children effectively. In this narrative review, we discuss the key challenges faced globally while caring for children with T1DM and DKA during the COVID-19 pandemic, and the lessons learned thereof.

Introduction: Jaundice is a common problem that affects up to 50-60% of full-term babies and 80% of preterm babies. It is a benign condition, but sometimes it can cause profound complications and eventually death. Identifying the treatment outcome of jaundice and the factors affecting it is crucial to preventing the death associated with it.

Objective: To determine the treatment outcome of jaundice and its associated factors among neonates treated in neonatal intensive care unit of comprehensive and specialized hospitals of SNNPR, Ethiopia, 2022.

Methods: An institution-based retrospective follow up study was conducted from April 2018 to April 2022. The data was checked for completeness and then entered into Epi-data version 4.6 and exported to STATA version 17. The results were presented in frequencies and percentages for categorical variables as well as mean and median for continuous variables. A binary logistic regression model was used to estimate the effect of an independent variable and the outcome variable.

Results: A total of 423 charts were reviewed, and 416 (98%) were included in the final analysis. Almost 91.3% (95% CI: 88.2, 93.7) of neonates had improved. Factors significantly associated with the treatment outcome were: residence (AOR = 0.36, 95% CI: 0.2, 0.8); origin of admission (AOR = 0.35, 95% CI: 0.2, 0.8); gestational age (AOR = 0.26, 95% CI: 0.1, 0.8); and total serum bilirubin level (AOR = 0.40, 95% CI: 0.2, 0.9).

Conclusion and recommendation: Improvement was lower compared to other low and middle-income countries; more emphasis should be given to improving treatment outcomes in hospitals.

Introduction: Three years ahead of the plan, Ethiopia has met Millennium Development Goal 4 of reducing under-five mortality. Additionally, the nation is on track to achieve the Sustainable Development Goal of putting an end to preventable child mortality. Despite this, recent data from the nation showed that there were 43 infant deaths for every 1000 live births. Moreover, the country has fallen short of the 2015 Health Sector Transformation Plan goal, with an anticipated infant mortality rate of 35 deaths per 1000 live births in 2020. Thus, this study aims to identify the time to death and its predictors among Ethiopian infants.

Methods: This study used the 2019 Mini-Ethiopian Demographic and Health Survey data set to conduct a retrospective study. The analysis used survival curves and descriptive statistics. Multilevel mixed-effects parametric survival analysis was applied to identify the predictors of infant mortality.

Results: The estimated mean survival time of infants was 11.3 months (95% CI: 11.1, 11.4). Women's current pregnancy status, family size, age of women, previous birth interval, place of delivery, and mode of delivery were significant individual-level predictors of infant mortality. Infants born with less than 24 months' birth interval had a 2.29 times higher estimated risk of death (AHR = 2.29, 95% CI: 1.05, 5.02). Infants born at home were 2.48 times more likely to die than those born in a health facility (AHR = 2.48, 95% CI: 1.03, 5.98). At the community level, women's education was the only statistically significant predictor of infant death.

Conclusion: The risk of infant death was higher before the first month of life, typically shortly after birth. Healthcare programs should put a strong emphasis on efforts to space out births and make institutional delivery services more readily accessible to mothers in Ethiopia to address the infant mortality challenges.

Adrenal insufficiency can arise from a primary adrenal disorder, secondary to adrenocorticotropic hormone deficiency, or by suppression of hypothalamic-pituitary-adrenal axis due to exogenous glucocorticoids. Diagnosis of adrenal insufficiency is usually delayed because the initial presentation is often subtle and nonspecific. Clinician awareness and recognition is crucial for timely diagnosis to avoid adrenal crisis. Current screening strategies for the diagnosis of adrenal insufficiency in children in various clinical situations are discussed in this review.

Background: During the COVID-19 pandemic, primary school children are particularly vulnerable as restriction measures have caused a huge impact on their health and well-being. This study aims to assess the prevalence of mental health among primary school children in Thailand during the COVID-19 pandemic and identify factors associated with psychosocial problems.

Methods: A survey was conducted among 701 Thai parents of primary school children from January to March 2022 - when teaching modalities between onsite and online learning were alternated. Parents were requested to assess the mental health of their youngest child at primary school age level. Psychosocial problems were measured by the Strengths and Difficulties Questionnaire (SDQ) with a total score of 40, based on 4 domains (emotion, behavior, hyperactivity, and relationship). Independent variables included (1) parental/household factors, (2) children characteristics, and (3) online learning-related issues. The dependent variable was the prevalence of children with a total score of 14-40, which indicates at risk and/or having mental health problems. The analysis was performed using logistic regression model.

Results: Thai parents reported that 41.1% of children had psychosocial problems. Children in a single-parent family (adjusted odds ratio [AOR] = 1.7; 95% confidence interval (CI) = 1.1-2.8), male children (AOR = 1.7, 95% CI = 1.2-2.4), and children who did not receive adequate assistance for online learning from their parents (AOR = 2.1, 95% CI = 1.1-4.0) significantly faced greater odds of mental health problems.

Conclusion: The prevalence of Thai primary school children confronting psychosocial difficulties during the COVID-19 pandemic increased, with significant concern. Public health interventions that aim to protect the mental health of primary school children during the pandemic should be introduced and targeted male children and those living with a single parent. Social support that facilitates online learning for children whose parents have limited capacity in supporting them should be implemented.

Background: Critical care is a multidisciplinary and interprofessional specialty devoted to treating patients who already have or are at danger of developing acute, life-threatening organ dysfunction. Due to the higher disease load and mortality from preventable illness, patient outcomes in intensive care units are challenging in settings with inadequate resources. This study aimed to determine factors associated with outcomes of pediatric patients admitted to intensive care units.

Methods: A cross-sectional study was conducted at Wolaita Sodo and Hawassa University teaching hospitals in southern Ethiopia. Data were entered and analyzed using SPSS version 25. Normality tests using the Shapiro-Wilk and Kolmogorov-Smirnov data were normally distributed. The frequency, percentage, and cross-tabulation of the different variables were then determined. Finally, the magnitude and associated factors were first analyzed using binary logistic regression and then multivariate logistic regression. Statistical significance was set at P < 0.05.

Results: A total of 396 Pediatric ICU patients were included in this study, and 165 (41.7%) deaths were recorded. The odds of patients from urban areas (AOR = 45%, CI 95%: 8%, 67% p-value = 0.025) were less likely to die than those in rural areas. Patients with co morbidities (AOR = 9.4, CI 95%: 4.5, 19.7, p = 0.000) were more likely to die than pediatric patients with no co-morbidities. Patients admitted with Acute respiratory distress syndrome (AOR = 12.86, CI 95%: 4.3, 39.2, p = 0.000) were more likely to die than those with not. Pediatric patients on mechanical ventilation (AOR = 3, CI 95%: 1.7, 5.9, p = 0.000) more likely to die than not mechanically ventilated.

Conclusion: Mortality of paediatric ICU patients was high (40.7%) in this study. Co-morbid disease, residency, the use of inotropes, and the length of ICU stay were all statistically significant predictors of death.