Journal of Tropical Pediatrics最新文献

{"title":"Probiotics for the prevention of ventilator-associated pneumonia and other outcomes in critically ill children: a systematic review and meta-analysis of randomized controlled trials.","authors":"Surya Kant Tiwari, Priya Tripathi, Kaushik Mukhopadhyay, Vineet Kumar Kamal, Neetu Priya, Athar Javeth, Rakesh Lodha, Poonam Joshi","doi":"10.1093/tropej/fmag057","DOIUrl":"10.1093/tropej/fmag057","url":null,"abstract":"<p><p>Critically ill children face high risks of mortality and healthcare-associated infections. Probiotics may improve outcomes by modulating gut microbiota and enhancing immune function. To evaluate the efficacy and safety of probiotics in critically ill children in pediatric intensive care units (PICUs). We systematically reviewed randomized controlled trials (RCTs) from PubMed, EMBASE, SCOPUS, and Web of Science until 10 June 2024. The primary outcome was all-cause mortality; secondary outcomes were ventilator-associated pneumonia (VAP), length of hospital stay (LOS), and duration of mechanical ventilation (MV). Risk ratios (RR) and mean differences (MD) were pooled using random-effects models (DerSimonian-Laird), with Hartung-Knapp adjustment as a sensitivity analysis. Evidence certainty was assessed using GRADE. Eight RCTs involving 744 children were included. Probiotics did not significantly reduce all-cause mortality (RR 0.85, 95% CI 0.66-1.11; P = .24; I² = 0%; low certainty); estimates were similar under Hartung-Knapp adjustment (RR 0.85, 0.69-1.06; P = .14) and in a sensitivity analysis restricted to low-risk-of-bias trials (RR 0.89, 0.60-1.34; P = .58). Probiotics significantly reduced VAP (RR 0.47, 95% CI 0.35-0.64; P < .0001; I² = 0%; high certainty), halving pneumonia risk (absolute risk reduction 21.9%; number needed to treat approximately 5). Reductions in LOS (MD -2.57 days, 95% CI -7.26 to 2.11; P = .20) and MV (MD -1.61 days, -4.43 to 1.20; P = .17) were nonsignificant (low certainty). No serious probiotic-associated adverse events occurred. High-certainty evidence indicates probiotics reduce VAP in critically ill children; the mortality effect was inconclusive. Probiotics may be considered an adjunctive strategy for VAP prevention in the PICU, pending larger multicenter trials.</p><p><strong>Prospero registry number: </strong>CRD42024546238.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of topical 5% permethrin and oral ivermectin for treatment of childhood scabies: a randomized controlled trial.","authors":"Nazima Khatun, Sayani Pan, Kamirul Islam, Sudipto Paul, Taraknath Ghosh","doi":"10.1093/tropej/fmag063","DOIUrl":"10.1093/tropej/fmag063","url":null,"abstract":"<p><p>Topical permethrin (5%), though considered the treatment of choice for scabies, has few drawbacks (expensive, poor compliance). This study aimed to compare the efficacy, safety, and cost-effectiveness of topical permethrin (5%) and oral ivermectin for treating childhood scabies. This randomized controlled trial was conducted in the dermatology and pediatric outpatient clinic of a tertiary care center between August 2023 and December 2024. Children in the study and control groups received oral ivermectin (200 µg/kg) and 5% permethrin, respectively, at an interval of 7 days. The cure rate at the 4th week was the primary outcome. Secondary outcomes were cure rate (1st and 2nd week), lesion count per patient (1st, 2nd, and 4th weeks), microscopic clearance (1st, 2nd, and 4th weeks), treatment failure (4th week), adverse events, reinfestation at the 6-month follow-up period, and cost to successfully treat one case. Three hundred and fifty-five children were included in either group. Though a significantly higher proportion of children in the control group were cured at the 1st week (41.8% vs 62.9%, p-value <.001), the cure rate was similar between the groups at the 2nd and 4th weeks (P-value >.05). Treatment failure was also similar in both groups (5.1% vs 3.9%, P-value = .47). The cost to treat one case successfully in the study and control groups was ₹44.2 ($0.46) and ₹140.4 ($1.47), respectively. Reinfestation during the follow-up period was similar in the two groups (P-value >.05). Oral ivermectin may be a cost-effective alternative treatment of childhood scabies. The trial was registered in the Clinical Trial Registry of India (Registration no.: CTRI/2023/07/055910, dated 31 July 2023).</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of paediatric dengue management over the past three decades-a historical perspective.","authors":"Janani Sankar, Padma Priya K H, Suchitra Ranjit","doi":"10.1093/tropej/fmag058","DOIUrl":"10.1093/tropej/fmag058","url":null,"abstract":"<p><p>Over the past three decades, the recognition and management of dengue fever (DF) and severe dengue (SD) in children have undergone significant transformation. In the 1990s, limited understanding of dengue pathophysiology led to delayed recognition, with aggressive fluid resuscitation, invasive ventilation, and frequent blood product use, often resulting in adverse outcomes. The 1997 World Health Organisation (WHO) Guidelines introduced a structured classification and emphasized cautious fluid management, improving survival. Advances in diagnostics, particularly non-structural (NS) protein antigen testing, enabled earlier detection in the 2000s. The revised WHO 2009 classification and recognition of Expanded Dengue Syndrome (EDS) in 2012 broadened the understanding of severe organ involvement beyond plasma leakage. In the 2020s, improved intensive care unit (ICU) technologies enabled advanced organ support, and the coronavirus disease of 2019 (COVID-19) pandemic highlighted potential viral interactions. Ongoing controversy remains regarding the role of immunomodulation for dengue-associated hyperinflammation. Continued clinical research is essential to refine management strategies and optimize outcomes in severe dengue.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten years after congenital Zika syndrome: lessons from a specialized multidisciplinary center in Brazil.","authors":"Thayla Amorim Santino, Gabriela Lopes Gama, Jousilene de Sales Tavares, Adriana Melo","doi":"10.1093/tropej/fmag062","DOIUrl":"https://doi.org/10.1093/tropej/fmag062","url":null,"abstract":"","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of lung point-of-care ultrasound in children with suspected pneumonia in a resource limited setting: a prospective observational study.","authors":"Jessica Schmidt, William Okiror, Nikolai Schnittke, Peter Olupot-Olupot","doi":"10.1093/tropej/fmag065","DOIUrl":"10.1093/tropej/fmag065","url":null,"abstract":"<p><p>Pneumonia is a leading cause of mortality for children under five worldwide and is often diagnosed using WHO clinical criteria. In resource-limited settings, accurate diagnosis remains challenging. Lung ultrasound (LUS) is an effective, low-cost diagnostic tool, however, its performance in smaller regional hospitals remains underexplored. We conducted a prospective observational study to evaluate the diagnostic yield of LUS among children hospitalized with WHO-defined pneumonia in Eastern Uganda. All children received a systematic 12-zone LUS by a trained operator using a linear probe in the sagittal plane. LUS was remotely interpreted by two blinded reviewers. Chest X-ray (CXR) was performed when feasible. We enrolled 46 patients with a total of 523 lung zones reviewed. The average age was 22 months (± 26.8 months); 67% of patients demonstrated hypoxemia. LUS was adequate in 42/46 (91%) children. LUS identified pneumonia in 25/42 (59%), bronchiolitis in 2/42 (5%), and normal lung in 15/42 (36%). CXR was completed in 40/46 (87%) children and showed pneumonia in 18/40 (45%). For the 36 children with both LUS and CXR, four (11%) demonstrated pneumonia on CXR but not LUS, compared to 11 (30%) who had pneumonia on LUS but not CXR. Our study demonstrated that LUS is feasible and identified features of pneumonia is 59% of LUS studies. While the overall diagnostic yield of LUS is comparable to CXR, a substantial proportion of children had pulmonary findings detected by only one imaging modality. These findings suggest a complementary rather than redundant role for LUS and CXR.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and antibiotic susceptibility of non-typhoidal Salmonella in immunocompromised children: a 15-year retrospective study in Thailand.","authors":"Pirakarn Phuphatrakun, Puttichart Khantee, Sarawut Sukkhum, Kamolwish Laoprasopwattana","doi":"10.1093/tropej/fmag041","DOIUrl":"10.1093/tropej/fmag041","url":null,"abstract":"<p><p>We aimed to evaluate the outcomes, antibiotic susceptibility of non-typhoidal Salmonella (NTS), and risk factors of invasive NTS (iNTS) infections in immunocompromised children. This is a retrospective observational study of immunocompromised children under 15 years of age with microbiologically proven NTS infections at Songklanagarind Hospital from January 2007 to December 2021. Among the 96 patients with NTS, 41 were diagnosed with hematologic malignancies, 26 with solid tumors, 6 with primary immunodeficiencies, and 23 with other immunodeficiencies, including nephrotic syndrome, autoimmune disorders treated with steroids, and aplastic anemia. NTS isolates collected during 2007-2012 and 2013-2021 demonstrated comparable susceptibility rates to ceftriaxone (100% and 93%, respectively), whereas susceptibility to ciprofloxacin decreased from 100% to 85.5%. Among the 96 patients, 21 (21.9%) had iNTS infections, including bacteremia (n = 19), urinary tract infections (UTIs; n = 2), and musculoskeletal infection (n = 1). One patient had concurrent UTI and osteomyelitis. The overall mortality rate among iNTS cases was 14.3%. In multivariable analysis, immunocompromised children with a sickly appearance, absence of gastrointestinal symptoms, and/or other immunodeficient conditions were at increased risk for iNTS infection, with predictive scores of 2.5, 2.7, and 2.8, respectively. A score ≥2.7 significantly predicted iNTS infection, with an area under the curve of 0.88. The sensitivity and specificity were 0.80 and 0.77, respectively. Nearly 22% of immunocompromised children had iNTS infection. Ceftriaxone remains an appropriate empirical treatment for suspected iNTS infection.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving towards radiation-free tertiary care NICU: a quality improvement initiative.","authors":"Ranganatha A Devaranavadagi, Shivashankar Diggikar, Netra S Kannur, G C Rajeev, Karthik Nagesh","doi":"10.1093/tropej/fmag051","DOIUrl":"https://doi.org/10.1093/tropej/fmag051","url":null,"abstract":"<p><p>Neonates admitted to intensive care are exposed to frequent radiation due to various reasons. Radiation hazard is an overlooked entity among neonates. Hence, this quality improvement (QI) project was conducted to address the issue. We aimed to reduce the average number of X-rays per neonate in our tertiary neonatal intensive care unit (NICU) from a baseline mean of 1.98 to ≤1.5 within 6 months (March to August 2024) through implementation of the as low as reasonably achievable principle and increased use of point-of-care ultrasound as an alternative to radiography. A dedicated QI team comprising neonatology consultants, residents, nursing staff, and radiography technicians was constituted. In the baseline phase, data on the total number of X-rays performed per patient were analysed over 6 months (August 2023 to January 2024). Contributing factors to increased radiation exposure were identified using a fishbone analysis. Subsequently, a series of stepwise plan-do-study-act cycles was implemented to reduce radiation exposure among neonates. During the baseline period, a total of 204 X-rays were performed on 103 neonates admitted to our NICU, with a mean (±SD) of 1.98 ± 2.16 X-rays per patient. Following the intervention phase (March 2024 through August 2024), a total of 179 X-rays were recorded among 125 neonates, with a reduced mean (±SD) of 1.43 ± 2.72 X-rays per patient. The effective implementation of targeted QI strategies was associated with a reduction in radiation exposure among neonates admitted to the NICU.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of urinary homocysteine levels in children with idiopathic nephrotic syndrome.","authors":"Srikanth Balduri, Om P Mishra, Ashok Singh, Surendra P Mishra, Priyanka Dua, Akash Mishra","doi":"10.1093/tropej/fmag043","DOIUrl":"https://doi.org/10.1093/tropej/fmag043","url":null,"abstract":"<p><p>Homocysteine, vitamin B12, and folic acid metabolism can be altered in idiopathic nephrotic syndrome (INS). Primary objective was to measure urinary homocysteine, serum vitamin B12, and folic acid levels in INS and controls. Secondary objectives were to compare the levels among different sub-groups of patients and also to find out correlations of homocysteine with biochemical parameters. Sixty children [16 with first-episode nephrotic syndrome (FENS), 15 with infrequent relapsing nephrotic syndrome (IRNS), 15 with frequent relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS), 14 with steroid-resistant nephrotic syndrome (SRNS)], 12 controls, and 19 patients in remission were enrolled. Urinary homocysteine, serum vitamin B12, and folic acid were measured in active and remission. Median urinary homocysteine/creatinine level was significantly raised in FENS as compared to controls, FRNS/SDNS, and SRNS (P < 0 .001), and normalized during remission. Mean serum vitamin B12 (P < 0.001) and median folic acid (P = 0.004) values were significantly lower in INS sub-groups than controls. During remission, both serum folic acid and vitamin B12 levels showed significant rise; the latter became greater than controls. Urinary homocysteine/creatinine correlated inversely with serum protein (r = -0.363, P < 0.001), albumin (r = -0.349, P < 0.01), and vitamin B12 (r = -0.227, P = 0.030), while showed positive correlations with serum cholesterol (r = 0.304, P = 0.003) and urine protein-creatinine ratio (r = 0.479, P < 0.001). Urinary homocysteine concentration was increased, and serum folic acid and B12 levels were decreased during active phase of the disease. Levels decreased during remission and became comparable with controls.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial to evaluate the efficacy and safety of a double-walled incubator compared to a radiant warmer in the care of extremely low-birth-weight infants.","authors":"Nandkishor S Kabra, Sameet S Umate, Poulami Halder, Haribalakrishna Balasubramanian","doi":"10.1093/tropej/fmag040","DOIUrl":"10.1093/tropej/fmag040","url":null,"abstract":"<p><p>This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of hematological parameters including systemic immune-inflammation index and percentage of immature granulocytes in predicting acute pyelonephritis.","authors":"Esra Ensari, Esra Nagehan Akyol Onder, Pelin Ertan","doi":"10.1093/tropej/fmag042","DOIUrl":"https://doi.org/10.1093/tropej/fmag042","url":null,"abstract":"<p><p>Early differentiation of acute pyelonephritis (APN) from lower urinary tract infection (LUTI) and identification of children at risk for renal scarring remain clinical challenges. We aimed to evaluate the diagnostic and prognostic performance of complete blood count (CBC)-derived inflammatory markers, particularly systemic immune-inflammation index (SII) and immature granulocyte percentage (IG%). In this retrospective single-center study (January 2013-December 2023), 265 children with confirmed urinary tract infections (UTIs) were classified as APN (n = 132) or LUTI (n = 133). Patients with prior antibiotic use or conditions affecting inflammatory markers were excluded. CBC-derived indices and IG% were analyzed. Renal ultrasonography was performed in all patients, and Technetium-99m dimercaptosuccinic acid scintigraphy was used during follow-up to assess renal scarring. Diagnostic performance was evaluated using receiver operating characteristic analysis, and independent predictors were assessed with multivariable logistic regression. C-reactive protein (CRP), neutrophil count, SII, IG%, and neutrophil-to-lymphocyte ratio (NLR) were significantly higher in APN compared to those in LUTI (all p < .001). Renal scarring was detected in 48 of 115 (41.7%) APN patients. Patients with renal scarring had higher CRP, SII, IG%, neutrophil count, and NLR, and lower lymphocyte levels. SII showed the highest discriminative performance [area under the curve (AUC) = 0.941, 95% confidence interval: 0.902-0.980) with a cut-off of 750 × 10³/µL (sensitivity 91%, specificity 86%). IG% (AUC = 0.895) and CRP (AUC = 0.891) also performed well. SII [odds ratio (OR) = 2.87] and IG% (OR = 1.42) remained independent predictors. SII and IG% are inexpensive, readily available biomarkers that may improve early risk stratification for renal scarring in children with UTI. Given that these parameters are derived from routine CBC tests at no additional cost, they may offer a practical and scalable approach to risk assessment in low- and middle-income settings where access to advanced imaging is limited.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}