Journal of Tropical Pediatrics

Manzar, Shabih

2023 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmad028pmid: 37674389

Niranjana, Sugunan; Singh, Chongtham Shyamsunder; Devi, Khuraijam Ranjana; Singh, O Okendrajit; Smilie, Chabungbam; Nandeibam, Sareet Kumari

2023 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmad031pmid: 37715501

ObjectivesTo assess the clinical profile of infants with late onset sepsis admitted in a tertiary care hospital in North-East India.MethodsProspective observational study was carried out in Department of Paediatrics, Regional Institute of Medical Sciences hospital during a period of 2 years (September 2019–August 2021).ResultsA total of 109 patients were included in the study, of which 80 were community-acquired and 29 infants were hospital-acquired cases of late onset sepsis (LOS). The major risk factors were low socioeconomic status, prematurity, low birth weight, a history of intervention (mechanical ventilation, umbilical venous catheter, total parenteral nutrition, resuscitation) and lack of exclusive breastfeeding. The most common presenting features were decreased feeding, lethargy and respiratory distress. Blood cultures were positive in 33% of patients. Klebsiella was the most common hospital-acquired pathogen while Escherichia coli was the most common isolate in community-acquired cases. Thrombocytopenia was the most common complication. The in-hospital mortality rate was 13.7%.ConclusionLow socioeconomic status, low birth weight, prematurity, invasive interventions and lack of exclusive breastfeeding are the major risk factors of LOS. The clinical signs and symptoms are varied and subtle. The mean C-reactive protein in the hospital-acquired group was significantly higher as compared to the community-acquired group. There is substantial morbidity and mortality, resulting in an increased toll on resources, therefore, an aggressive preventive and treatment approach is recommended for late onset sepsis.

Dos Santos, Maria Luiza Bernardes; Lima, Luiz Cláudio Santos De Souza; Zin, Andrea Araújo; Moreira, Maria Elisabeth Lopes; De Vasconcelos, Zilton Farias Moreira; Neves, Luiza Maceira De Almeida; Pereira, Maurício Bastos; Vianna, Renata Artimos De Oliveira; Velarde, Luis Guillermo Coca; De Oliveira, Solange Artimos; Riley, Lee Woodland; Cardoso, Claudete Aparecida Araújo

2023 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmad030pmid: 37705261

IntroductionCongenital Zika syndrome (CZS) is a recently described disease. Our main objective was to evaluate and monitor, over 3 years, the ophthalmoscopic findings in children exposed to zika virus (ZIKV) during gestation.MethodsThis prospective observational study was conducted in Rio de Janeiro, Brazil, between April 2016 and May 2019. We evaluated two groups with exanthema serving as a proxy for viremia: (i) children whose mothers had exanthema during pregnancy and (ii) children who had microcephaly without maternal exanthema during pregnancy. We performed indirect ophthalmoscopy at recruitment and every 6 months thereafter. We also tested the association between ocular findings with maternal exanthema, microcephaly, CZS and maternal infection confirmed by reverse transcriptase quantitative polymerase chain reaction and gender.ResultsOf the 72 children included, 16 (22.2%) had optic nerve and/or retinal lesions. All 16 had CZS and 15 (93.7%) had microcephaly (14 at birth and 1 postnatally). The child with postnatally acquired microcephaly was born to a mother without exanthema during pregnancy. Fifty-six (77.8%) of the 72 children were followed for a median time of 24 months and none exhibited differences between admission and follow-up examinations. After logistic regression, only microcephaly at birth was associated with eye abnormalities (odds ratio, 77.015; 95% confidence interval, 8.85–670.38; p < 0.001).ConclusionWe observed that there was no progression of the lesions over the follow-up period. We also showed that the eye findings were associated only with microcephaly at birth. Attention should be paid to all children born during a ZIKV epidemic, regardless of maternal exanthema and/or microcephaly at birth.

Huang, Jiyi; Guo, Zhibin; Duan, Junkai; Zou, Yong; Chen, Kuai; Huang, Hui; Zhang, Sheng; Zhou, Yunguo

2023 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmad027pmid: 37674390

Coronavirus disease 2019 (COVID-19) has become a significant global public health problem. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes the disease, utilizes angiotensin-converting enzyme II (ACE2) as a major functional receptor to enter host cells. No study has systematically assessed ACE2 expression in multiple tissues in children. This study investigated ACE2 expression and ACE2 protein’s histological distribution in various organs in paediatric patients (the small intestine, thymus, heart and lungs). Our study revealed that ACE2 was highly expressed in enterocytes of the small intestine and widely expressed in the myocardium of heart tissues. The most notable finding was the positive staining of ACE2 in the Hassall’s corpuscles epithelial cells. Negligible ACE2 expression in the lung tissues may contribute to a lower risk of infection and fewer symptoms of pneumonia in children than in adults with COVID-19 infection. These findings provide initial evidence for understanding SARS-CoV-2 pathogenesis and prevention strategies in paediatric clinical practice, which should be applicable for all children worldwide.

Pudjiadi, Antonius Hocky; Putri, Nina Dwi; Wijaya, Stephanie; Alatas, Fatima Safira

2023 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmad029pmid: 37697654

AimThis study aimed to explore the factors contributing to mortality and its management among pediatric sepsis patients at a single center in Indonesia.MethodWe conducted a retrospective study of children admitted due to sepsis from January 2015 to December 2019 in an Indonesian tertiary hospital.ResultsThe mortality rate of pediatric sepsis in our study was 76.1% among 176 records with outcome identified. Mortality was significantly associated with septic shock at triage, number of organ failure, intensive care unit admission, inotropic use, septic shock and severe sepsis during hospitalization. Timing of antibiotic use did not affect mortality. Death within the first 24 h occurred in 41.8% of subjects, mostly due to septic shock.ConclusionThis study illuminates the current state of pediatric sepsis management in our Indonesian hospital, revealing it as inadequate. Findings highlight the need for improved pre-hospital systems and sepsis recognition tools, and wider use of mechanical ventilators and advanced monitoring due to limited pediatric intensive care unit beds. Future research should focus on hospital-specific sepsis protocols to reduce pediatric sepsis mortality rates.