Journal of Tropical Pediatrics最新文献

{"title":"Moving the needle towards evidence-based guideline development in resource-constrained settings.","authors":"Joseph L Mathew","doi":"10.1093/tropej/fmag045","DOIUrl":"https://doi.org/10.1093/tropej/fmag045","url":null,"abstract":"","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":"148283885","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":"Hyperferritinemia in hospitalized children with dengue-a prospective observational study.","authors":"Liya Varghese, Abhijit Choudhary, Megha Jayachandran, Apurva Bhoyar, Vishwajeet Singh, Akash Bang, Shikha Jain, Urmila Dahake, Meenakshi Girish","doi":"10.1093/tropej/fmag049","DOIUrl":"10.1093/tropej/fmag049","url":null,"abstract":"<p><p>Dengue is a major cause of pediatric hospitalization in tropical countries and low- and middle-income countries (LMICs), where early recognition of severe disease remains challenging. Severe dengue is characterized by dysregulated immune activation and systemic inflammation, leading to organ dysfunction. Ferritin, an acute-phase reactant, has been increasingly studied as a potential biomarker of dengue severity, although pediatric data from LMIC settings remain limited. The aim of this study was to assess the prevalence of hyperferritinemia among children admitted with dengue with warning signs and severe dengue, and to correlate ferritin levels with clinical outcomes including organ dysfunction, new-onset multiple organ dysfunction syndrome, thrombocytopenia, need for ventilation, pediatric intensive care unit (PICU) admission, and duration of hospital stay. This single-center prospective observational study included children aged 1 month-18 years admitted to the pediatric ward or PICU with dengue with warning signs or severe dengue over a 6-month period. Serum ferritin was measured at admission. Demographic, clinical, and laboratory data were collected and analyzed. Among the 52 enrolled children, 42 (80.8%) had dengue with warning signs and 10 (19.2%) had severe dengue. Hyperferritinemia was observed in 26/42 (61.9%) children with warning signs and in 9/10 (90%) children with severe dengue. When stratified using a ferritin cutoff of 3000 μg/l, children with ferritin ≥3000 μg/l had significantly lower platelet counts during hospital stay (P-value = .004), increased hematological (P-value = .002) and respiratory dysfunction (P-value = .044), and a higher proportion of severe dengue cases (P-value = .01). Hyperferritinemia is common among hospitalized children with dengue and is associated with thrombocytopenia and organ dysfunction, supporting ferritin as a marker of disease severity.</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":"148412353","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":"Stool microscopic findings in school-aged children presenting with recurrent abdominal pain in Enugu, South-East Nigeria: a cross-sectional study.","authors":"Kenneth E Odo, Francis N Ogbuka, Adaeze C Ayuk, Ngozi R Mbanefo, Odutola I Odetunde","doi":"10.1093/tropej/fmag011","DOIUrl":"https://doi.org/10.1093/tropej/fmag011","url":null,"abstract":"<p><p>Recurrent abdominal pain (RAP) is a prevalent paediatric concern, particularly in low- and middle-income countries (LMICs) where parasitic infections are often overlooked as contributors. The aim is to evaluate stool microscopy findings among children with RAP in Enugu, Nigeria, and assess associations with age, sex, and inflammatory markers. This was a retrospective review of 168 children aged 3-15 years presenting with RAP between 2016 and 2022. Stool specimens were examined for yeast cells, Entamoeba histolytica cysts, and helminth ova. Associations with demographics and stool red blood cells/white blood cells were assessed using chi-square tests. The result showed that Yeast cells were found in 96.4% of samples, E. histolytica cysts in 64.9%, and helminth ova in 58.3%, predominantly Ascaris lumbricoides. No statistically significant associations were observed between age, sex, inflammatory markers, and organism presence (P > .05). In conclusion high prevalence of intestinal organisms in children with RAP suggests routine stool microscopy remains essential in LMICs.</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":"148562286","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":"Crimean-Congo Hemorrhagic Fever in Children: Secondary Hemophagocytic Lymphohistiocytosis and Time-course of Biomarkers in a Single-Center Cohort (2019-25).","authors":"Aylin Irmak Kuruc, Kubra Aykac, Osman Oğuz Demir, Gamze Gürsoy, Tekin Aksu, Selin Aytaç, Ali Bulent Cengiz, Yasemin Ozsurekci","doi":"10.1093/tropej/fmag048","DOIUrl":"10.1093/tropej/fmag048","url":null,"abstract":"<p><p>Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral infection that may present mildly in children but can progress to severe clinical states due to secondary hemophagocytic lymphohistiocytosis (HLH). We retrospectively analyzed the clinical, laboratory, and treatment data of children aged 0-18 years with polymerase chain reaction (PCR)-confirmed CCHF who were hospitalized at Hacettepe University, a large referral center for CCHF, between January 2019 and July 2025. Serial laboratory values (Days 0, 3, 7, and 10) and therapeutic interventions were evaluated. Twenty-two children (median age 13 years, 72% male) were included. The most frequent symptoms were fever (100%), bradycardia (59%), and conjunctival hyperemia (41%). HLH was diagnosed in 18 patients (82%). Ribavirin (91%), intravenous immunoglobulin (IVIG) (86%), and corticosteroids (68%) were administered. Platelet counts began to recover by Day 7, whereas ferritin declined gradually and normalized later. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels showed a progressive decrease. No patient required intensive care, and none died. Secondary HLH was highly prevalent among pediatric CCHF cases, yet outcomes were favorable with early antiviral and immunomodulatory therapy. Platelet recovery and delayed ferritin normalization may serve as practical biomarkers of disease resolution. Prospective multicenter studies with cytokine and viral-load profiling are warranted.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of periviable neonates after implementation of the Tiny Baby Protocol: a prospective study from India.","authors":"Divya Ajith, Femitha Pournami, Ajai Kumar Prithvi, Arif Abdulsalam Kolisambeevi, Naveen Jain","doi":"10.1093/tropej/fmag044","DOIUrl":"https://doi.org/10.1093/tropej/fmag044","url":null,"abstract":"<p><p>Outcomes of periviable gestations in low- and middle-income countries (LMICs) depend on perinatal practices and tailored care strategies. The unit implemented a revised \"Tiny Baby Protocol\" (TBP) in 2023 for neonates born at periviable gestations (23-25 weeks). This prospective study compared survival and short-term outcomes in 23-25 weeks gestation neonates who received care by TBP (preferred proactive approach to perinatal care, elective intubation, respiratory care practices including volume guarantee and high frequency ventilation, inhaled nitric oxide, sedation, skin care practices, transpyloric feeding, rectal wash-outs, and targeted management of perfusion and patent ductus arteriosus) to those from a previous epoch who had received intensive care before TBP was implemented. Thirty-one periviable (23-25 weeks) neonates received care by TBP, of whom 58.1% survived, compared to 35.2% before TBP. Survivors (with TBP) required median (interquartile range) of 22 (14-32) days of ventilation, 9 (8-10) days of parenteral nutrition, and 104 (95-121) days of hospital stay, compared to 19 (13-42), 7 (6-12), and 95 (86-108) days of each respectively in the previous epoch. Changes in survival rates were observed after implementation of the TBP; from 0% to 60% at 23 weeks, 37.5% to 50% at 24 weeks, and 50% to 71.4% at 25 weeks. Implementation of a revised TBP policy for periviable neonates was associated with improved survival when compared to previous epoch of intensive care given in a neonatal intensive care unit in the South Kerala region in India. Wide-scale implementation of such protocols needs to be studied to examine if survival increases in other LMICs.</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":"148272179","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":"Impact of quality improvement initiative on incidence of hypothermia in neonates in the delivery room.","authors":"Swati Rani, Shweta Singh Kalyani, Anchala Bhardwaj, Mahima Mittal, Preeti Priyadarshini, Ankita Kabi, Manish Kumar, Kriti Mohan, Mamata Gupta, Shubhangi Chaturvedi","doi":"10.1093/tropej/fmag006","DOIUrl":"https://doi.org/10.1093/tropej/fmag006","url":null,"abstract":"<p><p>Normothermia during the first hour of life predicts admission to neonatal intensive care unit (NICU) and improves the outcome for both sick and stable babies across all gestational ages. Immediate skin-to-skin contact (iSTS) offers a simple, effective approach to prevent hypothermia while enhancing feeding, survival, and bonding. The aim of this study is to implement a multidisciplinary quality improvement initiative addressing the barriers to optimal thermal care in the delivery room setting and establish sustainable protocols for preventing neonatal hypothermia across all gestational ages. The objective is to reduce the rate of hypothermia (temperature <36.5°C recorded just before transfer from the delivery room) from the existing 51.67% to <50% of the baseline data (<25.8%) in neonates over 12 weeks in the delivery room. This prospective Quality Improvement Study was undertaken to enhance newborn care in a tertiary-care hospital's delivery room from January 2024 to May 2024. A multidisciplinary team of Neonatologists/Pediatricians, Obstetricians, Anesthesiologists, OT staff, and Nurses identified problem areas using fishbone analysis. A situational analysis was conducted through process flow mapping, and three Plan-Do-Study-Act cycles were undertaken. In the first cycle, protocols were established through a multidisciplinary meeting involving consultants, pediatricians, anesthesiologists, and obstetricians. Resident doctors and nursing staff received educational sessions through manikin-based Objective Structured Clinical Examination drills. The second cycle focused on iSTS, maintaining optimal temperatures and ensuring equipment readiness in the operating room. During the third cycle, pre-operative counselling for mothers and sensitization of post-operative staff were implemented to further improve newborn care practices. Of the 148 neonates analysed (January 2024 to May 2024), hypothermia incidence (<36.5°C) decreased significantly from 51.67% to 13.16% (P < .001), representing a 74.5% relative improvement and an 85% reduction in odds (odds ratio = 0.15; 95% confidence interval: 0.08-0.28). Mean admission temperature increased from 36.2 ± 0.4°C to 36.8 ± 0.3°C (P < .001). Data collected on the incidence of hypothermia in cycles 1, 2, 3 showed hypothermia rates of 31.7%, 37.03%, and 22.58%, respectively, with cycle 2's increase attributed to heightened staff awareness and improved monitoring. STS ≥60 min increased from 25% to 85% (P < .001) and early breastfeeding from 30% to 78% (P < .001). The incidence of hypothermia was maintained at 13.16% through the 3-week sustainability phase, with no adverse events associated with the interventions. Implementation of simple evidence-based practices led to a significant decrease in hypothermia incidence in newborns after delivery. Immediate STS and using a head cap after birth are the two most important key interventions for preventing neonatal hypothermia in the delivery room.</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":"148648841","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 13-year cohort study using clinical machine learning to differentiate bacterial and viral infections in young infants in a dengue hyperendemic region.","authors":"Lucas J Cortés-Guzmán, Doris M Salgado, Carlos F Narváez","doi":"10.1093/tropej/fmag050","DOIUrl":"10.1093/tropej/fmag050","url":null,"abstract":"<p><p>Differentiating bacterial from viral infections in febrile young infants is challenging, particularly in dengue-hyperendemic regions. We developed and internally validated a clinical machine-learning model to enhance diagnostic accuracy in this risk population in Colombia. We retrospectively analyzed a pediatric infectious admission cohort (<18 years) at a reference hospital in southern Colombia from 2007 to 2019. 4671 admissions (2251 bacterial and 2420 viral) were included. Nine clinical and laboratory variables were used to train an eXtreme Gradient Boosting (XGBoost) classifier. We divided the data into development (70%) and test (30%) sets, with Youden's J statistics defining the optimal threshold. Penalized logistic regression (LR) and single-marker rules [leukocytosis, C-reactive protein (CRP)] served as comparators. The young-infant XGBoost achieved an area under the receiver-operating characteristic curve (AUC) of 0.896, outperforming LR (0.790) and single markers (0.746-0.706). Sensitivity was 93.5%, specificity 76.1%, positive predictive value 87.9%, and negative predictive value 86.4% in the temporal validation cohort. Discrimination was highest in children aged 6-10 years (AUC 0.967). CRP positivity, leukocytosis >16 × 10³ µl-1, and thrombocytopenia <150 × 10³ µl-1 were the most informative features. A nine-variable XGBoost model using routine clinical and hematologic variables accurately differentiated bacterial from viral infections in children from a low-resource dengue-endemic setting. Performance remained stable during temporal validation. Improved specificity with preserved sensitivity supports earlier targeted therapy and antibiotic stewardship. Multicenter studies and exploration of clinical challenges are the next steps for this kind of tool.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior mesenteric artery Doppler after first feed and its association with feed intolerance and necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study.","authors":"Hemant Namdeo Patil, Amol Kalyanrao Joshi, Laxmikant Sheshrao Deshmukh, Atul C Londhe","doi":"10.1093/tropej/fmag046","DOIUrl":"https://doi.org/10.1093/tropej/fmag046","url":null,"abstract":"<p><p>To evaluate the association of superior mesenteric artery (SMA) Doppler parameters after the first feed with feed intolerance and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) neonates. This prospective cohort study was conducted in a tertiary neonatal intensive care unit from July 2024 to January 2025. VLBW neonates underwent SMA Doppler assessment before and 60 min after the first feed using standardized protocols. The primary outcome was time to full enteral feeds; secondary outcomes included feed intolerance, NEC, and sepsis. Fifty neonates were included. Post-feed resistive index (RI) decreased significantly (0.76-0.68; P = .01). On adjusted analysis, SMA Doppler parameters were not independently associated with time to full feeds, while respiratory distress syndrome (RDS) and hemodynamically significant patent ductus arteriosus (hsPDA) were significantly associated. Median time to full feeds was 9 days on Kaplan-Meier analysis. Neonates with feed intolerance had lower post-feed pulsatility index (PI) and RI, and a greater fall in RI. ROC analysis showed modest discrimination (AUC 0.69, 95% CI 0.53-0.84). Doppler differences in neonates with NEC were not statistically significant; an exploratory model showed modest discrimination (AUC 0.72, 95% CI 0.50-0.87). SMA Doppler parameters show possible association with feed intolerance and NEC but have limited predictive value as standalone markers. Feeding progression appeared to be more strongly influenced by systemic illnesses such as RDS, hsPDA, and by clinical management factors including feed withholding and individualized advancement decisions.</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":"148345719","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":"Biomarker-guided antibiotic duration strategies using C-reactive protein and/or procalcitonin for neonatal sepsis: a scoping review.","authors":"Aditya Hemendra Bhatt, Ankur Patel, Praful Bhambharoliya, Kirti Mehta","doi":"10.1093/tropej/fmag052","DOIUrl":"https://doi.org/10.1093/tropej/fmag052","url":null,"abstract":"<p><p>Prolonged empirical antibiotic exposure in neonates is associated with adverse outcomes and antimicrobial resistance. Serial C-reactive protein (CRP) and procalcitonin (PCT) measurements may support earlier discontinuation, but neonatal protocols remain heterogeneous. To map evidence on CRP- and/or PCT-guided antibiotic-duration strategies in neonatal sepsis and summarize their effects on antibiotic exposure and safety. Following Joanna Briggs Institute guidance and PRISMA-ScR, PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library were searched from inception to December 2023. Peer-reviewed English-language studies of neonates aged 0-28 days with suspected, probable or culture-proven early- or late-onset sepsis were included when serial CRP and/or PCT formed part of an explicit antibiotic-stopping strategy. Two reviewers independently screened records and charted study characteristics, protocols and outcomes. Fifteen studies involving 4755 neonates were included: five randomized trials, six cohort studies, two prospective observational studies and two systematic reviews with meta-analyses. Seven studies evaluated CRP-guided discontinuation, six evaluated PCT-guided strategies and four used combined approaches. Biomarker-guided care reduced mean antibiotic duration from 7.3 to 4.5 days, a mean reduction of 2.8 days (38.6%). Reductions were directionally consistent and appeared greater in early-onset than late-onset sepsis. Thirteen studies reported treatment failure and 14 reported mortality; neither outcome showed an apparent increase with biomarker-guided discontinuation. Antimicrobial-resistance, ecological and cost outcomes were infrequently reported. CRP- and/or PCT-guided stopping strategies may reduce antibiotic exposure in neonatal sepsis without an apparent increase in treatment failure or mortality. Standardized protocols and further implementation, cost-effectiveness and resistance-focused research are needed, particularly in resource-limited settings and extremely preterm infants.</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":"148689441","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":"Efficacy of Bacillus clausii as an adjuvant therapy in pathological neonatal unconjugated hyperbilirubinemia in the Nile Delta region of Egypt: a randomized controlled trial.","authors":"Samah S M Hussein, Sahar M El-Haggar, Sahar K Hegazy, Mohamed A Rowisha","doi":"10.1093/tropej/fmag047","DOIUrl":"10.1093/tropej/fmag047","url":null,"abstract":"<p><p>Neonatal jaundice (NJ) is a common condition that may progress to serious complications such as kernicterus. Probiotics can also be used for treatment of jaundice by their effect on intestinal motility and microbial flora of the intestine. We aimed to evaluate the effect of probiotic supplementation as an adjuvant therapy in pathological neonatal unconjugated hyperbilirubinemia. A randomized, parallel-group comparative study was conducted on 44 neonates with confirmed pathological unconjugated hyperbilirubinemia admitted to the Neonatal Intensive Care Unit at Tanta University Hospital (Egypt) between May 2024 and April 2025. Participants were randomized (1:1) into two groups: phototherapy alone (control group n = 22) and phototherapy plus oral Bacillus clausii probiotic (probiotic group n = 22). Demographic data and bilirubin fractions were recorded. The primary outcome was the change in bilirubin levels; secondary outcomes included inflammatory biomarkers. Baseline characteristics were comparable between groups. Both groups exhibited significant declines in total serum bilirubin and indirect bilirubin, but only the probiotic group showed a significant reduction in direct bilirubin. By the end of treatment, the probiotic group showed a significantly greater reduction in lipopolysaccharide and tumor necrosis factor-α levels compared with the control group. Hospital stay was significantly shorter with probiotic therapy (3.8 ± 1.18 vs 6.3 ± 2.14 days; P < .001). Bacillus clausii supplementation alongside phototherapy significantly enhanced bilirubin reduction, decreased inflammatory markers, and shortened hospitalization, supporting its role as a beneficial adjunct therapy in neonatal hyperbilirubinemia.</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":"148360916","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}