Paediatrics and International Child Health最新文献

{"title":"Iron-deficiency anaemia in childhood: a risk factor for severe venous thrombosis?","authors":"Antonietta Curatola,&nbsp;Serena Ferretti,&nbsp;Antonio Gatto,&nbsp;Piero Valentini,&nbsp;Ilaria Lazzareschi","doi":"10.1080/20469047.2021.1923301","DOIUrl":"https://doi.org/10.1080/20469047.2021.1923301","url":null,"abstract":"<p><p>Iron deficiency anaemia is a common disorder in the paediatric age-group. The association between iron deficiency and venous thrombosis in children without an underlying illness is rare. Two cases are described. A 17-year-old girl had been taking oestrogen-progestogen therapy for contraception for about 2 years and developed a lower-limb deep vein thrombosis associated with pulmonary embolism. A 3-year-old girl was admitted to the paediatric emergency department with pallor, weakness and vomiting, and a cerebral CT showed a recent cerebral venous thrombosis. Both cases had severe iron-deficiency anaemia which increases a thrombotic tendency and could be a further crucial trigger of venous thrombosis in patients at low risk; therefore, in cases of unexplained thrombosis, it must always be considered to be a risk factor.<b>Abbreviations</b> APCR: activated protein C resistance; CMV: cytomegalovirus; CT: computerised tomography; CVST: cerebral venous sinus thrombosis; CVT: cerebral venous thrombosis; DVT: deep vein thrombosis; DOACs: direct oral anticoagulants; EBV: Epstein-Barr virus; ID: iron deficiency; IDA: iron deficiency anaemia; LMWH: low molecular weight heparin; PE: pulmonary embolism; RDW: red blood cell distribution width; VT: venous thrombosis.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"42 1","pages":"36-40"},"PeriodicalIF":1.8,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1923301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38993915","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 gastric outlet thickened mucosal fold associated with cytomegalovirus infection in an extremely preterm infant managed by surgical resection.","authors":"Susmitha Tangirala,&nbsp;Prakash Amboiram,&nbsp;Umamaheswari Balakrishnan,&nbsp;Sandhya Sundaram,&nbsp;Prakash Agarwal,&nbsp;Usha Devi","doi":"10.1080/20469047.2021.1967626","DOIUrl":"https://doi.org/10.1080/20469047.2021.1967626","url":null,"abstract":"<p><p>Non-bilious vomiting in preterm neonates discharged from neonatal intensive care units is a common complaint and is often associated with benign conditions such as gastro-oesophageal reflux. A neonate of 27 weeks gestation who presented later with vomiting owing to gastric outlet obstruction is described. He was discharged at 11 weeks of age and required re-admission 1 week later. He had persistent non-bilious vomiting from 7 weeks of age, failure to thrive and metabolic alkalosis. Clinical examination demonstrated visible gastric peristalsis, and hypertrophic pyloric stenosis was suspected. Ultrasound of the gastric pylorus and upper gastro-intestinal contrast studies were negative. Exploratory laparotomy after failure of conservative management revealed a thickened mucosal fold in the gastric pylorus, which was excised. Histopathology demonstrated inclusion bodies which are pathognomonic of cytomegalovirus infection. He was treated with valganciclovir for 6 weeks and was asymptomatic and thriving well at follow-up. Gastric outlet obstruction can be one of the manifestations of CMV infection of the gastro-intestinal tract. Diagnosis can be confirmed only by histopathology.<b>Abbreviations:</b> BPD: bronchopulmonary dysplasia; CMV: cytomegalovirus; H&E: haematoxylin and eosin; IHC: immunohistochemistry; IHPS: infantile hypertrophic pyloric stenosis; NEC: necrotising enterocolitis; PCR: polymerase-chain reaction; VGP: visible gastric peristalsis.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"42 1","pages":"41-44"},"PeriodicalIF":1.8,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39413772","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 study comparing short-term outcome in preterm infants of ≤30 weeks gestation between a tertiary neonatal care unit in Bangalore, India and one in London, UK","authors":"Shivashankar Diggikar, N. Nagesh, N. A. Kumar, N. Aladangady","doi":"10.1080/20469047.2022.2054916","DOIUrl":"https://doi.org/10.1080/20469047.2022.2054916","url":null,"abstract":"ABSTRACT Background Large numbers of preterm infants are born in middle-income countries and neonatal care is improving in these countries. Few studies have compared clinical outcome in preterm infants in a tertiary neonatal unit in a middle-income country with one in a high-income country. Objective To compare the short-term outcome in preterm infants of ≤30 weeks gestation admitted to a tertiary neonatal unit in Bengaluru, India and in London, UK. Methods This was a retrospective observational study using anonymised data from electronic patient records. Preterm infants born at ≤30 weeks gestation admitted to neonatal units in Bengaluru (n = 294) and London (n = 740) over a 5-year period (January 2011 to December 2015) were compared. Results Fewer mothers in the Bengaluru centre received antenatal steroids (37% vs 73%, p < 0.001). The incidence of retinopathy of prematurity requiring treatment (12.9% vs 7.7%, NS), treated patent ductus arteriosus (32.3% vs 10.7%, NS) and blood culture-positive sepsis (32.4% vs 1.7%, p < 0.001) was higher in infants in the Indian centre. Overall survival was 83% vs 87.2% (NS) in the Bengaluru and the London cohorts, respectively. Survival of infants born at ≤28 weeks gestation was lower in Bengaluru than in London [24 weeks: 33.0% vs 79.3% (NS); 25 weeks: 50.0% vs 78.9%, p = 0.02; 26 weeks: 45.2% vs 86.5%, p < 0.01; 27 weeks: 79.3% vs 91.3% (NS); 28 weeks 82.5% vs 94.1%, p = 0.03]. Conclusion The survival of infants ≤28 weeks gestation was significantly lower in the Bengaluru centre. Increasing the provision of antenatal corticosteroids may improve the outcome in these infants. Abbreviations BPD: bronchopulmonary dysplasia; CPAP: continuous positive airway pressure; EPR: electronic patient records; HIC: high-income countries; HDU: high dependency unit; hsPDA: haemodynamically significant patent ductus arteriosus; IVH: intraventricular haemorrhage; ITU: Intensive Care Unit, IUGR: intrauterine growth restriction; LAMA: leaving against medical advice; LMIC: low- and middle-income countries; NICU: neonatal intensive care unit; NNFI: National Neonatal Forum of India; NS: not significant; NTS: neonatal transfer service; NNAP: National Neonatal Audit Programme; NHM: National Health Mission; NMR: neonatal mortality rate; NEC: necrotising enterocolitis; NS: not significant; PDA: patent ductus arteriosus; ROP: retinopathy of prematurity; SCBU: special care baby unit; VLBW: very low birthweight; WHO: World Health Organization","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"42 1","pages":"5 - 11"},"PeriodicalIF":1.8,"publicationDate":"2022-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49040491","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":"Ulcerative colitis in patients with sickle cell disease: a rare but important co-morbidity","authors":"Angela E. Rankine-Mullings","doi":"10.1080/20469047.2022.2084964","DOIUrl":"https://doi.org/10.1080/20469047.2022.2084964","url":null,"abstract":"Abbreviations : COVID-19: Coronavirus disease 2019; HIC: high-income countries; IBD: inflammatory bowel disease; LMIC: low- and middle-income countries; PUCAL: paediatric ulcerative colitis activity index; SCD: sickle cell disease; UC: ulcerative colitis","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"42 1","pages":"1 - 4"},"PeriodicalIF":1.8,"publicationDate":"2022-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43492889","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 spectrum and burden of in-patient paediatric musculoskeletal diseases in Northern Tanzania","authors":"Rebecca B Walsh, Anthon G Mwingwa, Nateiya M. Yongolo, S. M. Biswaro, M. Mwanswila, C. Kelly, B. Mmbaga, Faith Mosha, W. Gray, E. McIntosh, R. Walker","doi":"10.1080/20469047.2022.2062561","DOIUrl":"https://doi.org/10.1080/20469047.2022.2062561","url":null,"abstract":"ABSTRACT Background Musculoskeletal diseases (MSD) are a major contributor to the global burden of disease and disability, and disproportionally affect low- and middle-income countries; however, there is a dearth of epidemiological data. Affected children often face increased morbidity, social isolation and economic hardship. Aim To assess the spectrum and burden of paediatric MSD in children aged 5–18 years admitted to a major referral hospital in Tanzania. Methods This was a retrospective cohort study of children aged 5–18 years admitted to Kilimanjaro Christian Medical Centre (KCMC) whose initial diagnosis was recognised as a musculoskeletal condition by the International Classification of Diseases-10 between 1 January and 31 December 2017. Results During 2017, 163 cases of confirmed paediatric MSD were admitted to KCMC, representing 21.2% of all admissions of children aged 5–18 years (n = 769). Bone disease was the most common diagnosis. They comprised 106 (65.0%) traumatic fractures, 31 (19.0%) osteo-articular infections, 9 (5.5%) malunions and 3 (1.8%) pathological fractures. Congenital defects and rheumatic disease were relatively uncommon, accounting for only 6 (3.7%) and 4 (2.5%) MSD admissions, respectively. Conclusion The majority of cases of MSD were related to fractures, followed by osteo-articular infections, while recognised cases of rheumatic disease were rare. The study, although small, identified the sizeable burden and spectrum of paediatric MSD admitted to a hospital in Tanzania over a 12-month period and highlights the need for larger studies to inform the optimal allocation of health resources. Abbreviation CI: confidence interval; HIC: high-income countries; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; IQR: interquartile range; JIA: juvenile idiopathic arthritis; KCMC: Kilimanjaro Christian Medical Centre; LMIC: low- and middle-income countries; MSD: musculoskeletal diseases: NAI: non-accidental injury; NIHR: National Institute for Health Research; PAFLAR: Paediatric Society of the African League Against Rheumatism; RTA: road traffic accidents; SCD: sickle cell disease; SLE: systemic lupus erythematosus; SSA: sub-Saharan Africa.","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"42 1","pages":"12 - 21"},"PeriodicalIF":1.8,"publicationDate":"2022-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41812763","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 subarachnoid pleural fistula with massive crystal-clear pleural fluid caused by a lumbar epidural teratoma","authors":"Toshihiro Fujiki, R. Nishimura, Raita Araki, M. Kuroda, Y. Tohma, H. Fujisawa, A. Yachie","doi":"10.1080/20469047.2022.2044675","DOIUrl":"https://doi.org/10.1080/20469047.2022.2044675","url":null,"abstract":"ABSTRACT A subarachnoid pleural fistula — a connection between the pleural cavity and the subarachnoid space — generally presents after trauma or surgery. A 1-year 11-month-old girl without a history of trauma or surgery presented with fatigue, cyanosis and dyspnoea. A chest radiograph and computed tomography (CT) demonstrated a massive pleural effusion in the right hemithorax. About 300 ml of a crystal-clear pleural effusion, which looked like pure water, was removed by insertion of a chest drain, but it continued to collect. Cisternography and CT myelography confirmed leakage of cerebral spinal fluid into the right pleural cavity around the thoracolumbar region. Magnetic resonance imaging demonstrated an 11-mm enhanced nodule in the epidural space around the right lumbar (L) 1/2 intervertebral foramen. The patient underwent surgery and epidural tumours attached to the L1 nerve root foramen were completely resected and a fistula of the dura adjacent to the tumour was sutured. Histopathological examination demonstrated a mature teratoma containing a pancreatic component. On retrospective analysis of stored pleural fluid, a raised level of pancreatic enzymes was detected. It is presumed that digestive enzymes secreted by the pancreatic component of the teratoma lysed the dura, resulting in formation of the fistula. When a crystal-clear pleural effusion is present, even in the absence of trauma or surgery, a subarachnoid pleural fistula should be considered. As far as we know, this is the first report of a subarachnoid pleural fistula caused by a paravertebral teratoma. Abbreviations: CSF: cerebrospinal fluid; CT: computed tomography; 111In-DTPA: indium-111 diethylene triamine penta-acetic acid; MRI: magnetic resonance imaging; NIPPV: non-invasive positive pressure ventilation.","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"42 1","pages":"52 - 57"},"PeriodicalIF":1.8,"publicationDate":"2022-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41728793","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":"Haematohidrosis in a 12-year-old boy: blood, sweat and tears.","authors":"Milan Talwar,&nbsp;Aakash Chandran Chidambaram,&nbsp;Suresh Mekala,&nbsp;Narayanan Parameswaran,&nbsp;C G Delhikumar","doi":"10.1080/20469047.2021.1951555","DOIUrl":"https://doi.org/10.1080/20469047.2021.1951555","url":null,"abstract":"<p><p>A 12-year-old boy presented with a 1-year history of episodes of spontaneous bleeding from multiple sites lasting for a few minutes. His medical history was unremarkable and all the episodes of bleeding began after he was separated from his aunt to whom he was very much attached. She had moved out of their home following her marriage. All haematological investigations were normal. He was diagnosed with haematohidrosis secondary to adjustment disorder, and behavioural therapy was advised and propranolol prescribed. At present he is asymptomatic and on regular follow-up.<b>Explanations of terms used in the text</b>: Adjustment disorder: maladaptive response to a psychosocial stressor in an individual with significant difficulty coping with a stressful psychosocial event; anxiolytics: medication that reduces anxiety; chromohydrosis: secretion of coloured sweat; haematochezia: passage of fresh blood through the anus, usually in or with stools; haematohidrosis: sweating blood; oto-erythrosis: spontaneous bleeding from the ear; otorrhagia: haemorrhage from the ear; vicarious menstruation: cyclical bleeding outside the uterine cavity during the menstrual cycle.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":" ","pages":"300-302"},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1951555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197614","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":"Complications associated with myocardial bridging in four children without underlying cardiac disease: a case series.","authors":"Federica Brancato,&nbsp;Donato Rigante,&nbsp;Marco Piastra,&nbsp;Alessandro Gambacorta,&nbsp;Claudia Aurilia,&nbsp;Gabriella De Rosa","doi":"10.1080/20469047.2021.1891819","DOIUrl":"https://doi.org/10.1080/20469047.2021.1891819","url":null,"abstract":"<p><strong>Background: </strong>Myocardial bridging is largely considered to be a benign, symptomless congenital anomaly of the coronary arteries in which the intramyocardial coronary course is partially 'tunnelled' and leads to vessel compression during ventricular systole. There are few data regarding children.</p><p><strong>Objective: </strong>To report on myocardial bridging observed in children seeking medical help in the paediatric emergency room.</p><p><strong>Case presentation: </strong>A series of four children aged 6-13 years with symptomatic myocardial bridging but no other underlying cardiac abnormalities is reported. They were admitted to the paediatric emergency department during 2013-2016, three with chest pain after physical activity and one with septic shock.</p><p><strong>Results: </strong>Heart computed tomography scan in the first three demonstrated myocardial bridging of the left anterior descendent coronary artery's branches; their 2-year follow-up was uneventful. The fourth patient presented with ventricular fibrillation 24 hours after admission and at autopsy there was an intramyocardial tract 4 cm long on the left anterior descendent coronary artery.</p><p><strong>Conclusions: </strong>This case series demonstrates that myocardial bridging can be symptomatic in children with no underlying cardiac disorders and should be included in the differential diagnosis of exertional chest pain and/or arrhythmias.<b>Abbreviations:</b> CRP, C-reactive protein; CT, computed tomography; D1, diagonal 1 artery; ECG, electrocardiogram; ED, emergency department; KD, Kawasaki disease; LAD, left anterior descending coronary artery; MB, myocardial bridging; RI, ramus intermedius artery; TN, troponin.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":" ","pages":"278-284"},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1891819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39082925","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":"Prevalence and management of vitamin D deficiency in children with newly diagnosed coeliac disease: cohort study.","authors":"Akhshayaa G,&nbsp;Anju Seth,&nbsp;Praveen Kumar,&nbsp;Anju Jain","doi":"10.1080/20469047.2021.1996089","DOIUrl":"https://doi.org/10.1080/20469047.2021.1996089","url":null,"abstract":"<p><strong>Background: </strong>Coeliac disease (CD) causes deficiency of various micronutrients including vitamin D, and there are no specific guidelines for treatment.</p><p><strong>Aims: </strong>To determine the prevalence of vitamin D deficiency in children newly diagnosed with CD and the role of oral high-dose vitamin D in its treatment.</p><p><strong>Methods: </strong>Calcium intake, sun exposure and biochemical and radiological parameters related to vitamin D deficiency were compared between 60 children aged 0-18 years diagnosed with CD and 60 healthy age- and sex-matched controls. The cases with serum 25(OH)D (<20 ng/ml) were given oral vitamin D (60,000 IU/week) and calcium (500 mg/day) for 12 weeks, along with a gluten-free diet (GFD); they were re-evaluated within a week of completion. The primary outcome measure was the serum 25(OH)D level, and secondary measures included serum calcium, phosphorus, alkaline phosphatase, parathormone and clinical and/or radiological rickets.</p><p><strong>Results: </strong>The prevalence of vitamin D deficiency (25(OH)D <20 ng/ml) was significantly greater in the cases (<i>n</i>=38, 63.3%) than in the controls (<i>n</i>=27, 45.0%). Upon treatment, all 38 cases with vitamin D deficiency showed a significant rise in 25(OH)D levels along with normalisation of other biochemical abnormalities. Two children had 25(OH)D levels >100 ng/ml with no other feature suggestive of vitamin D toxicity.</p><p><strong>Conclusions: </strong>Vitamin D deficiency is more prevalent in children with CD. Administration of oral high-dose vitamin D for 12 weeks along with a GFD leads to a robust response, indicating rapid mucosal recovery. The vitamin D dosage recommended for malabsorption states may be excessive in CD.<b>Abbreviations:</b> ALP: alkaline phosphatase; CaBP: calcium-binding proteins; CD: coeliac disease; GFD: gluten-free diet; PTH: parathormone; RU: reproducibility units; 25(OH)D: 25 hydroxy vitamin D.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":" ","pages":"247-252"},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39692478","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":"Relationship between distance of referring facilities and haemoglobin change in children in Malawi.","authors":"Elizabeth M Keating,&nbsp;Jeff A Robison,&nbsp;Msandeni Chiume,&nbsp;Marissa Taddie,&nbsp;James A VanDerslice,&nbsp;L Scott Benson,&nbsp;Elizabeth Fitzgerald,&nbsp;Heather L Crouse,&nbsp;Michelle D Eckerle,&nbsp;Emily J Ciccone,&nbsp;Christina A Porucznik","doi":"10.1080/20469047.2022.2044674","DOIUrl":"https://doi.org/10.1080/20469047.2022.2044674","url":null,"abstract":"<p><strong>Background: </strong>Anaemia is a significant cause of mortality in children in sub-Saharan Africa where blood transfusion is often available only at referral hospitals. Understanding the pattern of referrals by health facilities is essential to identify the delays that affect child survival.</p><p><strong>Aim: </strong>To determine if there was a correlation between change in haemoglobin (Hb) level and distance from referring facilities to Kamuzu Central Hospital (KCH) in Malawi, and whether distance affected mortality rates.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 2259 children referred to KCH whose Hb was measured at the referring facility or at KCH. Maps were created using ArcGIS® software. The relationship between distance from KCH and change in Hb was assessed by χ² analysis and multiple linear regression with SAS© software.</p><p><strong>Results: </strong>The majority of children were referred by health facilities in the Lilongwe District. When categorised as Hb <4, 4-6 or >6 g/dL, 87.0% of children remained in the same category during transfer. There was no significant relationship between Hb drop and distance from KCH. Distance from KCH was not a significant predictor of Hb level at KCH or Hb change. However, mortality rates were significantly higher in facilities that were 10-50 km from KCH than in those which were <10 km away.</p><p><strong>Conclusions: </strong>Using distance as a proxy for time, this suggests that referring facilities are transferring children sufficiently quickly to avert significant reductions in Hb. Despite this, there is a need to identify the factors that influence the decision to transfer anaemic children.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 4","pages":"253-261"},"PeriodicalIF":1.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9050928/pdf/nihms-1784970.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10093618","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}