Journal of Tropical Pediatrics

Chen, Wenfeng; Dong, Hongba; Yang, Xiaoqing

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae046pmid: 39511431

This study explored the clinical characteristics of Chlamydia trachomatis (C. trachomatis) pneumonia in children and the risk factors for severe C. trachomatis pneumonia. This retrospective case-control study included children with C. trachomatis pneumonia who were admitted to the Department of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen University (Xiamen, China) between January 2018 and December 2021. Among 117 children, 33 (28.2%) had severe C. trachomatis pneumonia and 84 children had mild-to-moderate C. trachomatis pneumonia. According to the results of the binary logistic regression analysis, congenital heart disease [odds ratio (OR) = 0.09, 95% confidence interval (CI): 0.01–0.74, P-value = .024], mixed infection (OR = 0.17, 95%CI: 0.05–0.51, P-value = .002), white blood cell count greater than 15 000 cells/dl (OR = 1.20, 95%CI: 1.03–1.40, P-value = .022), and partial pressure of carbon dioxide (PaCO2) (OR = 1.14, 95%CI: 1.02–1.26, P-value = .016) were found as independent predictive factors for severe C. trachomatis pneumonia in children. This study explored key risk factors for severe C. trachomatis pneumonia, a condition underreported in tropical regions where pediatric respiratory infections are a leading cause of morbidity and mortality. By identifying risk factors, such as congenital heart disease, mixed infections, and elevated PaCO2, this research may guide early intervention strategies in resource-limited settings, potentially reducing pediatric pneumonia deaths.

Kumar, Vishal; Barik, Sitanshu; Garg, Varun; Raj, Vikash; Arora, Shobha S

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae043pmid: 39424291

Musculoskeletal infection of pelvis can be confused with septic arthritis of the hip, irritable hip, sacroiliitis, and spondylodiscitis in the initial period. This study aimed to present the complete clinical picture of pelvic infective osteomyelitis (PIO) in children along with its natural course. Two researchers independently used PubMed and Scopus electronic databases for the literature review. This review includes all studies reporting PIO in the pediatric age group. The final inclusion of 11 eligible studies was done. A total of 277 patients were analyzed from the included studies with the majority of males (158/242, 65.2%). Hip and groin pain (147/195, 75.3%) and limp (155/249, 62.2%) were the common presenting symptoms. Increased systemic temperature (83/103, 80.5%) and localized tenderness at the hip joint area (90/121, 74.3%) were among the commonest signs. Magnetic resonance imaging was an investigation of choice for diagnosis (89/93, 95.6%). Blood culture showed growth in 47.6% (119/250) patients with Staphylococcus aureus (83/102, 81.3%) being the most common isolated organism. Treatment with sensitive antibiotics was the mainstay of management with surgery for debridement or biopsy being required in only 16.1% (23/142) of the patients. PIO in children is a rare condition mimicking several other disease processes affecting the neighboring tissues the diagnosis of which gets limited in low-resource settings. Further prospective clinical studies are the need of the hour to validate the guideline proposed. Explorative studies to define a clinical scoring system to differentiate septic arthritis of the hip from PIO may be considered.

Verma, Akanksha; Verma, Manoj K; Priyanka, Vallepu L; Naranje, Kirti; Singh, Anita; Roy, Abhijeet; Paul, Abhishek; Phadke, Shubha; Kumar, Basant

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae038pmid: 39403812

Recent evidence shows a shift in neonatal mortality causes, with an increasing proportion due to birth defects. This study aimed to determine the prevalence and treatment outcomes of congenital anomalies (CAs) at a tertiary referral center in Northern India. This retrospective observational study was conducted over 7 years (May 2014–December 2021) and included all inborn and outborn neonates admitted with a diagnosis of CA as per ICD-10 classification in a level 3 NICU in North India. The prevalence of CAs was 8.9% (332 out of 3734 neonates). The most commonly affected systems were cardiovascular (33.4%), gastrointestinal (19.8%), and genitourinary (19.8%). While 57.5% of these defects could potentially be addressed through pediatric and cardiovascular surgery, only a small proportion of eligible neonates received timely surgical intervention due to delayed referrals and financial constraints. The mortality rate was 16.8%. This study highlights the significant burden of CAs in Northern India, emphasizing the need for enhanced capacity building, better facilities, and increased awareness for timely referrals. The findings underscore the importance of multidisciplinary collaborations and upgraded healthcare services to inspire further research and preventive strategies to mitigate birth defects. Given the context of a low- and middle-income country, this study’s insights into the prevalence, challenges, and outcomes of CAs are particularly relevant, highlighting the necessity of accessible and affordable healthcare solutions in such settings.

Pillay, Ashendri; Chetty, Terusha; Moore, David P; Waggie, Zainab; Nakwa, Firdose L; van Kwawegen, Alison; Thomas, Reenu; Karsas, Maria; Cloete, Jeané; Balakrishna, Yusentha; Reddy, Tarylee; Archary, Moherndran; Goga, Ameena; Jeena, Prakash

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae041pmid: 39419767

Antimicrobial resistance is a global threat in children, and the emergence of multi-drug-resistant organisms is of concern. This secondary analysis of an antimicrobial point prevalence survey (PPS) in children evaluates the impact of age on antimicrobial use. The mean antimicrobial prescriptions were assessed in neonates, infants, young children (1–5 years), school-going children (6–12 years), and adolescents (13–15 years) from a cross-sectional PPS at three academic hospitals between September 2021 and January 2022. Primary and secondary diagnoses, antibiotic type (World Health Organization AWaRe and Anatomical Therapeutic Chemical classifications), and the incidence of healthcare-associated infections (HAI) were evaluated per age category. Multiple regression models were used to analyse age-related risk factors for HAI. The number of antimicrobials per child (1.7–1.9 per patient) was higher in neonates and infants compared to children 6–12 years old (1.4 per patient). Watch antibiotics, especially carbapenems, were commonly prescribed in neonates (32.5%) and infants (42.2%). Reserve antimicrobial use was notable in neonates (4.7%) and infants (4.1%). The incidence risk ratio (IRR) of HAI was higher in neonates and infants (IRR 2.13; 95% CI 1.23–3.70, IRR 2.20; 95% CI 1.40–3.45, respectively) compared to 6- to 12-year-olds. On multivariate analysis of participants according to age, being HIV infected, length of stay >6 days, high McCabe severity score, having surgery and receipt of blood transfusion were associated with an increased risk of HAI (P < .001 for all) while on univariate analysis only, being premature and/or underweight was associated with an increased risk of HAI in infants (P < .001 for both). Infants with risk factors for HAI significantly influenced antimicrobial prescribing, underscoring the necessity for tailored antimicrobial stewardship and enhanced surveillance. The increased use of Watch antibiotics, particularly carbapenems, in infants warrants closer scrutiny. Further research is required to identify inappropriate antimicrobial use in high-risk hospitalized young children.

Fang, Kehong; Liu, Hui; Zhai, Bingzhong; Wang, Lingli; Zhao, Lijuan; Hao, Li; Huang, Liming; Zhang, Xuhui

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae040pmid: 39499903

Many studies have reported the relationship between eating rate and childhood overweight/obesity, while results remain inconclusive. The present study was done to estimate the association between eating rate and childhood overweight/obesity through a systematic review of prevalence studies. Relevant studies were searched by two independent researchers in databases including PubMed, Embase, Cochrane Library, and Web of Science, and data were collected from relevant studies published through June 2023 using predefined inclusion/exclusion criteria. A summary estimate was calculated using a random-effect model, and subgroup analysis was performed to explore sources of heterogeneity. Data from 16 published studies were eligible for inclusion. Fast eating was associated with a higher risk of overweight/obesity compared with a medium eating rate (OR = 1.80; 95% CI: 1.49, 2.18), and slow eating showed a declined overweight/obesity risk among children and adolescents (OR = 0.65; 95% CI: 0.52, 0.81). Subgroup analysis performed according to age showed that in all age groups, eating fast was positively correlated with overweight/obesity, while eating slowly was negatively associated with overweight/obesity. According to our study, eating rate was closely related to childhood overweight/obesity, and eating fast was associated with an increased likelihood of being overweight/obesity. In the future, it will be necessary to understand the factors that influence fast eating and develop methods to slow down the eating rate in children and adolescents.

García, Heladia; Ramos-Soto, Dulce Ivonne; Miranda-Novales, Guadalupe; Luna-Santos, Laura

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae039pmid: 39394777

Orotracheal intubation and mechanical ventilation (MV) have become routine practices in intensive care units. Unplanned extubation (UE) is one of the most important complications, particularly in premature infants and critically ill newborns. The objective of this study was to determine the prevalence of UE in a tertiary care neonatal intensive care unit (NICU). In this analytical cross-sectional retrospective study, all data, including perinatal data, indications for ventilatory support, days of MV at the time of UE, work shift, month of the event, reintubation, and postextubation complications, were obtained from the manual review of clinical charts. In total, 151 neonates, who received invasive MV, were included in this study. The prevalence of UE was 2.0/100 days of ventilation. The most affected were premature infants, with a gestational age of ≤ 32 weeks (54.7%) and a birth weight of ≤ 1500 g. The main cause for UE was deficient fixation of the endotracheal tube (ETT) (27.7%). Most UE events occurred during night shifts (48.1%). Reintubation was required in 83.3% of newborns. Immediate complications developed in 96.3% of the UE events, including desaturation (57.7%) and bradycardia (36.5%). The prevalence of UE was high, particularly in premature infants, with a high rate of reintubation and immediate complications. Standardized protocols for ETT care must be implemented to reduce these events.

Sarici, Serdar Ümit; Arslan, Kübra; Babacan, Altay; Soylu, Demet; Ergür, Ayca Törel; Serdar, Muhittin Abdulkadir; Sarici, Dilek

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae037pmid: 39390899

In this study, we aimed to determine an ordinary/empiric/standard phototherapy treatment protocol for duration without controlling total serum bilirubin (TSB) levels after initiating phototherapy in early-term and full-term jaundiced newborns who had no hyperbilirubinemia neurotoxicity risk factors. We compared two groups, each receiving either 24 h (Group I) or 18 h (Group II) of continuous phototherapy in terms of demographic characteristics and efficacy (rate of decrease in TSB levels with phototherapy). No control TSB measurements were performed in the study groups until the end of phototherapy for the predetermined durations. Declines in TSB after phototherapy were significantly greater in Group I than in Group II, both in terms of mg/dl (11.81 ± 2.93 mg/dl vs. 10.75 ± 2.48 mg/dl, P = .0008) and percentage (56.71 ± 9.06% vs. 52.86 ± 8.37%, P = .0002). However, the rate of TSB reduction after phototherapy in mg/dl/h (0.59 ± 0.13 mg/dl/h vs. 0.49 ± 0.12 mg/dl/h, P = <.0001) and percentage per hour (2.93 ± 0.37% vs. 2.36 ± 0.46%, P = <.0001) were significantly higher in Group II than in Group I. This indicates an inverse time-response relationship between the duration of phototherapy and the response rate in the study groups. Although the 24-h phototherapy course showed greater efficacy concerning the primary bilirubin outcome measures (decline in TSB in mg/dl and %), the 18-h course of phototherapy treatment provided better hourly outcomes and reached its saturation point around the 18th hour. Therefore, an 18-h phototherapy without TSB monitoring until the end of the phototherapy should be considered for jaundiced newborns lacking neurotoxicity risk factors.

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae042pmid: 39394778

Beura, Subhasree; Rath, Debasmita; Biswal, Basudev; Panigrahi, Mahima; Parida, Bikash

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae034pmid: 39394776

Orubu, Ejiroghene; Satrom, Katherine; Ezenwa, Beatrice; Fajolu, Iretiola; Lund, Troy; Obi, Abigail; Ezeaka, Chinyere; Slusher, Tina

2024 Journal of Tropical Pediatrics

doi: 10.1093/tropej/fmae050pmid: 39607988

G6PD deficiency (G6PDd) is the most common X-linked genetic disease worldwide and the most common cause of severe neonatal hyperbilirubinemia (NH) in Nigeria. Screening for G6PDd has been recommended for over thirty years but is still not routinely done in Nigeria. We sought to investigate a low-cost rapid diagnostic test to determine G6PDd in Nigerian neonates. Enrolled neonates were screened using the CareStartTM G6PD point-of-care rapid diagnostic test; and mothers/caregivers of neonates with G6PDd were asked about their cord care product(s); transcutaneous bilirubin levels were done on neonates with G6PDd using the JM 103 meter. One hundred and forty neonates were enrolled between 15 January and 1 July 2022. Eighteen (12.8%) of all neonates enrolled and 13.9% of enrolled males (0% of females) were G6PDd. Seventeen of the mothers/caregivers of the G6PDd neonates were asked about cord care. The majority of mothers/caregivers (15/17, 88%%) reported including methylated spirits in their neonate’s cord care; seven of these used chlorohexidine plus methylated spirits (41.2%) while only one mother/caregiver used chlorohexidine alone. One mother/caregiver used mentholatum alone and another used mentholatum, chlorhexidine gel, and methylated spirits. Maximum bilirubin levels for those infants with G6PDd ranged from 3.2 to 18.8 mg/dl with 16/17 (94.1%) of bilirubin levels exceeding 5.5 mg/dl. This study again highlights the need for large-scale G6PDd screening. Additionally, it highlights the need to correlate the type of cord care with the risk of NH in future studies.