Paediatrics and International Child Health最新文献

{"title":"Paediatric scurvy: frequently misdiagnosed.","authors":"Husna Musa,&nbsp;Imma Isniza Ismail,&nbsp;Nurul Hazwani Abdul Rashid","doi":"10.1080/20469047.2020.1816285","DOIUrl":"https://doi.org/10.1080/20469047.2020.1816285","url":null,"abstract":"<p><p>Paediatric scurvy is uncommon in the modern age but cases have been reported in children with neurodevelopmental issues and restricted dietary habits. The broad clinical picture is frequently overlooked as primarily other systemic diseases are considered first leading to extensive investigations and delay in diagnosis. A 4-year-old boy with autism and bilateral lower limb pain and refusal to walk is reported. His restricted diet and radiographic findings were highly suggestive of scurvy which was confirmed by the extremely low levels of ascorbic acid. Treatment with ascorbic acid replenishment and maintenance resulted in remarkable improvement. This case highlights the importance of a high index of suspicion in at-risk children so as to avoid unnecessary invasive investigations and procedures.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"158-161"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1816285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38483413","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":"Blood transfusion and mortality in children with severe anaemia in a malaria-endemic region.","authors":"Elizabeth M Keating, Msandeni Chiume, Elizabeth Fitzgerald, Yamikani Mgusha, Tisungane Mvalo, Nora Fino, Heather L Crouse, Michelle Eckerle, Kathleen Gorman, Emily J Ciccone, Gladstone Airewele, Jeff A Robison","doi":"10.1080/20469047.2021.1881270","DOIUrl":"10.1080/20469047.2021.1881270","url":null,"abstract":"<p><strong>Background: </strong>In children in sub-Saharan Africa, severe anaemia (SA) is an important cause of mortality, and malaria is a primary cause. The World Health Organization (WHO) recommends blood transfusion for all children with haemoglobin (Hb) <4 g/dL and for those with Hb 4-6 g/dL with signs of instability. In sub-Saharan Africa, evidence of the effect on mortality of transfusion in children with SA with and without malaria is mixed.</p><p><strong>Aim: </strong>To determine in children with and without malaria whether receipt of transfusion was associated with lower mortality at WHO transfusion thresholds.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 1761 children with SA (Hb ≤6 g/dL) admitted to Kamuzu Central Hospital in Malawi. In those whose Hb was 4-6 g/dL, mortality was compared by transfusion, stratified by haemoglobin, malaria status and signs of instability.</p><p><strong>Results: </strong>Children with profound anaemia (Hb <4 g/dL) and malaria were the only subgroup who had a significant decrease in the odds of in-hospital death if they received a transfusion (OR 0.43, <i>p</i> = 0.01). Although children with Hb 4-6 g/dL and at least one sign of instability had higher mortality than children with none, there was no difference in the odds of mortality between those who received a transfusion and those who did not (OR 1.16, <i>p</i> = 0.62).</p><p><strong>Conclusions: </strong>This study suggests that transfusion of children with profound anaemia and malaria may confer increased in-hospital survival. An understanding of the factors associated with mortality from SA will allow for interventions to prioritise the provision of limited blood.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"129-136"},"PeriodicalIF":1.4,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523581/pdf/nihms-1667283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38895635","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":"Association between cardiorespiratory fitness and cardiometabolic risk factors in Brazilian children and adolescents: the mediating role of obesity parameters.","authors":"Caroline Brand,&nbsp;Cézane Priscila Reuter,&nbsp;Anelise Reis Gaya,&nbsp;Jorge Mota,&nbsp;Michael Duncan,&nbsp;Leticia Borfe,&nbsp;Jane Dagmar Pollo Renner","doi":"10.1080/20469047.2020.1838758","DOIUrl":"https://doi.org/10.1080/20469047.2020.1838758","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of clarity as to which obesity parameters may be more important in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk factors (CMRF).</p><p><strong>Aim: </strong>To verify the mediating role of different obesity parameters on the association between CRF and CMRF in normal weight and overweight/obese children and adolescents.</p><p><strong>Methods: </strong>This cross-sectional study comprised 999 children and adolescents (534 boys) aged 7-14 years from the south of Brazil. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and percentage of body fat were assessed. Participants were classified as normal weight, overweight and obese according to BMI. CRF was evaluated by the 6-minute run/walk test. . A continuous CMRF score was calculated by summing the Z-scores of the following variables: systolic and diastolic blood pressure, glucose, total cholesterol, high-density lipoprotein cholesterol and triglycerides. Data analysis was performed using partial correlation and linear regression models.</p><p><strong>Results: </strong>BMI, WC, WHtR and percentage of body fat mediated the relationship between CRF and CMRF in overweight/obese boys and girls but not those of normal weight. Additionally, the percentage of the influence of each obesity parameter was 20% for BMI and WC, 16% for percentage of body fat and 18% for WHtR in girls. For boys, the mediation effect was 25% for BMI, 26% for WC, 28% for percentage of body fat and 25% for WHtR.</p><p><strong>Conclusion: </strong>Adiposity plays a central role in CMRF; therefore, maintaining an adequate weight status should be an important objective of health-promoting programmes in early age.</p><p><p><b>Abbreviations</b>: CMRF, cardiometabolic risk factors; CRF, cardiorespiratory fitness; BMI. body mass index; HDL-c, high-density lipoprotein cholesterol, PROCESS PROESP-Br, Projeto Esporte Brasil; SPSS, Package for Social Sciences; TC, total cholesterol; TG, triglycerides; WC, waist circumference; WHtR, waist-to-height ratio; %BF, percentage of body fat.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"93-102"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1838758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38537160","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":"An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report.","authors":"Özge Kaba,&nbsp;Manolya Kara,&nbsp;Zuhal Bayramoğlu,&nbsp;Emine Çalışkan,&nbsp;Bilal Çetin,&nbsp;Elnur Karimov,&nbsp;Ünsal Özkuvancı,&nbsp;Yasemin Özlük,&nbsp;Selda Hançerli Torun,&nbsp;Zeynep Nagehan Yürük Yıldırım,&nbsp;Hasan Orhan Ziylan,&nbsp;Ayper Somer","doi":"10.1080/20469047.2020.1822633","DOIUrl":"https://doi.org/10.1080/20469047.2020.1822633","url":null,"abstract":"<p><p>A 15-year-old girl was followed up for 2 years in a district hospital for management of vesicoureteral reflux and, subsequently, hydronephrosis of both kidneys and required bilateral ureteroneocystostomy. Despite surgery, there was continuous progression of the left hydronephrosis. Referral to a tertiary hospital because of continued sterile pyuria prompted investigation for tuberculosis (TB): she was diagnosed with bilateral pulmonary TB and urine culture confirmed <i>Mycobacterium tuberculosis</i>. Despite tuberculous chemotherapy and dexamethasone, she required a left nephrectomy. Histology demonstrated necrotising granulomatous pyelonephritis. She remains well with normal function of the right kidney. Despite the rarity, chronic urinary tract disorders should always prompt investigation for tuberculosis.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"154-157"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1822633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38432451","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 and laboratory features associated with mortality in children with severe malnutrition in Papua New Guinea.","authors":"Ian Kintwa,&nbsp;Paulus Ripa,&nbsp;Jonah Kurubi,&nbsp;Magdalynn Kaupa,&nbsp;Trevor Duke","doi":"10.1080/20469047.2021.1901435","DOIUrl":"https://doi.org/10.1080/20469047.2021.1901435","url":null,"abstract":"<p><p><b>Background:</b> The World Health Organization has a clinical and syndromic approach to the management of severe acute malnutrition which recognises that laboratory investigations are often not possible where children with severe malnutrition present. In low- and middle-income countries including Papua New Guinea, rates of death from severe malnutrition in many hospitals remain 10% or more.<b>Aim:</b> To evaluate the clinical predictors of death and the association between disturbances of electrolytes and haematological investigations in children with severe malnutrition and the risk of mortality.<b>Methods:</b> The clinical and laboratory predictors of death in a prospective cohort of 150 children with severe malnutrition admitted to a provincial hospital in Papua New Guinea were analysed. The clinical signs and electrolytes, complete blood count and liver function tests at presentation and on Days 3 and 5 were recorded.<b>Results:</b> The strongest independent predictors of mortality at assessment on admission were a low child Glasgow coma scale (≤12), hypoxaemia (SpO₂ <90%), prolonged capillary refill (>3 seconds) and dysnatraemia (<130 or >150 mmol/L). The area under the receiver operating characteristics curve for these four variables was 0.93.<b>Conclusions:</b> That three of these four criteria correspond closely to the WHO Emergency Clinical Signs reinforces the value of a system of triage and risk assessment in children with severe malnutrition. If a child has emergency signs they should be managed in an area on the ward where close monitoring and supportive care can be provided, the WHO guidelines for severe malnutrition followed, and other specific care provided. Measurements of serum sodium, particularly in children with diarrhoea and dehydration, is also important in risk assessment and management.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"123-128"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1901435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25542771","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":"Infantile nephrotic syndrome secondary to cytomegalovirus infection in a 7-month-old girl: resolution with ganciclovir.","authors":"Jasleen Kaur,&nbsp;Bobbity Deepthi,&nbsp;Rachita Singh Dhull,&nbsp;M D Faruq,&nbsp;Abhijeet Saha","doi":"10.1080/20469047.2020.1823176","DOIUrl":"https://doi.org/10.1080/20469047.2020.1823176","url":null,"abstract":"<p><p>Infantile nephrotic syndrome is a rare disorder which is frequently caused by genetic defects. A 7-month-old girl presented with fever, loose stools and anasarca and was diagnosed with nephrotic syndrome. Work-up for a genetic cause was negative. Cytomegalovirus polymerase chain reaction (CMV PCR) was positive and the infant was treated with ganciclovir for 6 weeks, followed by valganciclovir for 10 weeks. All symptoms resolved within 2 weeks of commencing treatment and she attained complete remission within 4 weeks. CMV PCR was negative within 4 weeks of antiviral therapy. At 18 months follow-up she remained well. Appropriate treatment of infantile nephrotic syndrome secondary to CMV should result in recovery.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"162-165"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1823176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38431956","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":"Decreasing antibiotic over-use by implementation of an antibiotic stewardship programme in preterm neonates in resource limited settings - a quality improvement initiative.","authors":"Anitha Kommalur,&nbsp;Vidyalakshmi Baddadka,&nbsp;Sahana Devadas,&nbsp;Mallesh Kariyappa,&nbsp;B Dakshayani,&nbsp;Shilpa Krishnapura Lakshminarayana,&nbsp;Suman P N Rao,&nbsp;Praveen Venkatagiri,&nbsp;Gayathri Devi Chinnappa,&nbsp;Sushma Veranna Sajjan","doi":"10.1080/20469047.2021.1886545","DOIUrl":"https://doi.org/10.1080/20469047.2021.1886545","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics play a critical role in neonatal sepsis but excessive use is associated with adverse outcomes and the current prescribing rates of antibiotics are unacceptably high.</p><p><strong>Aim: </strong>To reduce antibiotic over-use in preterm neonates by implementing an antibiotic stewardship programme using a quality improvement (QI) initiative.</p><p><strong>Methods: </strong>This study was conducted at a neonatal intensive care unit in a resource-limited setting. The reasons for antibiotic over-use were analysed and an antibiotic stewardship programme was implemented by using a QI initiative. The duration of the QI was a 1-month baseline phase followed by 3 months of implementation which was undertaken in the form of Plan-Do-Study-Act (P-D-S-A) cycles. The sustainment phase was observed for 2 months. All neonates admitted to the preterm unit were included. The outcome measure was the antibiotic usage expressed as days of therapy (DOT)/1000 patient days.</p><p><strong>Results: </strong>In the baseline phase, DOT/1000 patient days was 1464 which fell to 706, 511, and 442 DOT/1000 patient days, respectively, over 3 months, resulting in a 65% reduction in antibiotic usage. This was achieved by a combination of efforts directed towards defining the conditions for no antibiotics, revising existing antibiotic policy, stopping orders at 48 hours, de-escalation to the narrowest spectrum antibiotic, stopping prophylactic antifungal agents and limited use of broad-spectrum antibiotics. The results were achieved without an increase in culture-positive sepsis or mortality.</p><p><strong>Conclusions: </strong>Implementation of a tailored antibiotic stewardship programme through a QI initiative was effective and safe in reducing antibiotic use in preterm neonates in a resource-limited setting.</p><p><strong>Abbreviations: </strong>AIIMS, All India Institute of Medical Sciences; DOT, days of therapy; HIC, high-income countries; ICMR, Indian Council of Medical Research; LMIC, low- to middle-income countries; LOS, late-onset sepsis; NICU, neonatal intensive care unit; NNF, National Neonatology Forum; P-D-S-A, plan-do-study-act; QI, quality improvement; SNCU, Special newborn care unit.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"103-111"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1886545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25492585","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 rare case of metapneumovirus-induced rhabdomyolysis and multi-organ dysfunction in a 4-year-old child.","authors":"Aakash Chandran Chidambaram,&nbsp;Rohit Bhowmick,&nbsp;Narayanan Parameswaran,&nbsp;Dhandapany Gunasekaran","doi":"10.1080/20469047.2020.1814567","DOIUrl":"https://doi.org/10.1080/20469047.2020.1814567","url":null,"abstract":"<p><p>Human metapneumovirus (hMPV) is a common cause of acute respiratory tract infections in children. In immunocompetent individuals, the course of hMPV infection is usually benign and self-limiting. A developmentally normal, previously healthy 4-year-old girl presented with pneumonia and later developed rhabdomyolysis and multi-organ dysfunction syndrome (MODS) which was fatal. Extensive microbiological investigation for a possible viral aetiology was positive only for hMPV, thus making it the first reported case of hMPV infection-related rhabdomyolysis.<b>Abbreviations</b>: ARDS, acute respiratory distress syndrome; CK, creatinine kinase; hMPV, human metapneumovirus; MODS, multi-organ dysfunction syndrome; RSV, respiratory syncytial virus.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"166-169"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1814567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38461691","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":"Global mobility, travel and migration health: clinical and public health implications for children and families.","authors":"Elizabeth E Dawson-Hahn,&nbsp;Vaidehi Pidaparti,&nbsp;William Hahn,&nbsp;William Stauffer","doi":"10.1080/20469047.2021.1876821","DOIUrl":"https://doi.org/10.1080/20469047.2021.1876821","url":null,"abstract":"<p><p>Exponential growth of the world's population combined with increased travel has dramatically increased the spread of infectious diseases. Although there has been significant focus on migration, the major contributors to the transmission of communicable diseases are travel and tourism not migration. Given that children represent up to 10% of international travellers, it is critical to the health of all age groups to ensure that tailored guidance for children is considered in public health policy and guidelines, and pandemic responses. To further support pandemic preparedness, public health systems need to strengthen ties with communities and health systems. In addition, travel and migration issues need to be included as core competencies in medical education. Ensuring that clinicians who care for children have knowledge of travel and migration health will foster a better health outcome in an increasingly mobile population at risk of emerging infectious diseases.<b>Abbreviations</b> CDC: Centers for Disease Control and Prevention; DGMQ: CDC Division of Global Migration and Quarantine; EID: emerging infectious diseases; EU: European Union; VFR: visiting friends and relatives; IOM: United Nations International Organization for Migration; LPR: lawful permanent resident; US: United States of America; WHO: World Health Organization.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 1","pages":"3-11"},"PeriodicalIF":1.8,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1876821","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25518671","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":"Editorial.","authors":"Philip R Fischer","doi":"10.1080/20469047.2021.1872262","DOIUrl":"https://doi.org/10.1080/20469047.2021.1872262","url":null,"abstract":"","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 1","pages":"1-2"},"PeriodicalIF":1.8,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1872262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582737","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}