Comorbidities and Factors Associated with Mortality among Children under Five Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of Jinja Regional Referral Hospital, Eastern UgandaRead the full article
International Journal of Pediatrics provides a forum for pediatricians who diagnose and treat disorders in infants, children, and adolescents. Studies relate to pediatric subspecialities including adolescent medicine, cardiology, critical care etc.
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Pediatric Intensive Care Unit Admissions for COVID-19: Insights Using State-Level Data
Introduction. Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions. Materials and Methods. This is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state’s population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints. Results. A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25–12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, ). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, ) and intubation (beta coefficient 4.6, ). Conclusions. Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data.
Time to Relapse and Its Predictors among Children with Nephrotic Syndrome in Comprehensive Specialized Hospitals, Tigray, Ethiopia, 2019
Background. Relapse in children with nephrotic syndrome leads to a variety of complications due to prolonged treatment and potential dependency on steroids. However, there is no study conducted to determine the incidence and predictive factors of relapse for nephrotic syndrome in Ethiopia, especially in children. Thus, this study aimed to assess the incidence of relapse and its predictors among children with nephrotic syndrome in Ethiopia. Methods. A retrospective study was conducted by reviewing all charts of children with an initial diagnosis of the nephrotic syndrome in tertiary hospitals from 2011 to 2018. Charts of children with a diagnosis of steroid-resistant cases were excluded. The extraction tool was used for data collection, Epi-data manager V-4.4.2 for data entry, and Stata V-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, life table, and crude hazard ratios were used to describe the data and adjusted hazard ratios with 95% CI and value for analysis. Median relapse time, incidence rate of relapse, and cumulative relapse probabilities at a certain time interval were computed. Bivariable and multivariate analyses were performed using the Cox proportional hazard regression to identify the factors associated with relapse. Any variable at in the bivariable analysis was transferred to multivariate analysis. Then, the adjusted hazard ratio with 95% CI and was used to report the association and to test the statistical significance, respectively. Finally, texts, tables, and graphs were used to present the results. Results and Conclusion. Majority, 64.5% (40/66), of relapses were recorded in the first 12 months of follow-up. The incidence rate of relapse was 42.6 per 1000 child-month-observations with an overall 1454 child-month-observations and the median relapse time of 16 months. Having undernutrition [; 95% CI 1.78-6.65], elevated triglyceride [; 95% CI 1.04-10.90], decreased serum albumin level [; 95% CI 1.81-6.80], and rural residence [; 95% CI 1.49-10.76] increased the hazard of relapse. Conclusion and Recommendation. Relapse was higher in the first year of the follow-up period. Undernutrition, hypoalbuminemia, hypertriglyceridemia, and being from rural areas were independent predictors of relapse. A focused evaluation of those predictors during the initial diagnosis of the disease is compulsory.
Propionic and Methylmalonic Acidemias: Initial Clinical and Biochemical Presentation
PA and MAA have numerous nonspecific presentations, potentially leading to delayed diagnosis or misdiagnosis. In this paper, we present the clinical and biochemical characteristics of MMA and PA patients at initial presentation. Results. This is a retrospective review of 20 patients with PA () and MMA (). The most observed symptoms were vomiting (85%) and refusing feeding (70%). Ammonia was μmol/l, showing a negative correlation with pH and bicarbonate and positive correlation with lactate and anion gap. Peak ammonia did not correlate with age of onset ( and ) or age at diagnosis ( and ), nor did pH (, ; , ) or bicarbonate (, ; , ). There was no correlation between ammonia and C3 : C2 ( and ) or C3 ( and ). The glycine was μmol/l, and it was higher in PA (). There was a positive correlation between glycine and both pH ( and ) and HCO3 ( and ). There was no correlation between glycine and ammonia ( and ) or lactate ( and ). Conclusion. Clinical presentation of PA and MMA is nonspecific, though vomiting and refusing feeding are potential markers of decompensation. Blood gas, lactate, and ammonia levels are also good predictors of decompensation, though increasing levels of glycine may not indicate metabolic instability.
Clinical and Epidemiological Determinants of Lower Respiratory Tract Infections in Hospitalized Pediatric Patients
Background. Lower respiratory tract infection (LRTI) is the main cause of pediatric mortality and morbidity in low- and middle-income countries. Purpose. This study was carried out to determine the clinical and epidemiological characteristics of children with LRTI. Method. A retrospective study was conducted on all pediatric patients who were hospitalized due to LRTI in Abuzar Hospital (Ahvaz, Iran) during one year. Incomplete medical records and children who were treated on an outpatient basis, as well as infants younger than 1 month of age, were excluded. The patients were evaluated in terms of epidemiological, clinical, and paraclinical characteristics. Results. A total of 303 hospitalized children and infants were identified. Their mean age was months (range 1 month-15 years), and 59.4% of them were males. The highest frequency of patients was at the age below one year (50.8%, ). Pneumonia and bronchitis were the most common LRTIs. Respiratory (54.6%) and neurological (21.6%) diseases were the most prevalent underlying medical conditions. Admission was more common in winter (, 39.6%) and spring (, 26.1%). The mean length of stay (LOS) in the hospital was days, and the overall mortality rate was 11.6%. In addition, 65 patients were severely underweight and 271 patients were malnourished. Moreover, there was a significant association between mortality and disease diagnosis (). Furthermore, there was a significant association between having an underlying disease and consanguineous parents (), as well as the frequency of hospitalization (). Conclusion. Additional studies are required to determine factors contributing to disease severity among children with LRTI to develop appropriate preventive and therapeutic strategies.
Child Night Blindness and Bitot’s Spots Are Public Health Problems in Lay Armachiho District, Central Gondar Zone, Northwest Ethiopia, 2019: A Community-Based Cross-Sectional Study
Background. Night blindness (XN) is a condition in which a person cannot see in dim light and is the earliest clinical manifestation of vitamin A deficiency. Globally, vitamin A deficiency is a public health problem in 122 countries, of which 45 countries have moderate to severe child night blindness. Therefore, this study is aimed at assessing the prevalence and associated factors of night blindness and Bitot’s spot among children aged 24-59 months. Methods. A community-based cross-sectional study was employed from February to March 2019 among children aged 24-59 months in the Lay Armachiho District, Amhara region. A structured and pretested questionnaire was used for data collection. Descriptive summary statistics were used to describe the study population. Bivariate and multivariable logistic regression models were used to identify associated factors. Results. Out of 1007 children, 1.9% and 2.2% had night blindness and Bitot’s spot, respectively. Illiterate mothers (; ), age of 48 to 59 months (; ), ≥4 family sizes (; ), had diarrhea (; ), and had a respiratory tract infection (; ) were significantly associated with night blindness. Age of 48-59 months (; ) and mothers who did not wash their hands after using the toilet (; ) were predictor variables for Bitot’s spots. Conclusion. The prevalence of night blindness and Bitot’s spots was high. Child’s age, mother’s educational status, family size, diarrhea in the last 2 weeks, and respiratory tract infection in the last 2 weeks were predictive variables for night blindness. Besides, handwashing practice after using the toilet and child’s age were significantly associated with Bitot’s spot among children. Therefore, both night blindness and Bitot’s spots are a public health problem and call for the attention of health professionals in primary health care facilities.
Determinants of Neural Tube Defects among Newborns in Amhara Region, Ethiopia: A Case-Control Study
Background. Worldwide, an estimated 300,000 neonates are born with neural tube defects (NTDs) each year. However, NTDs are underreported in Ethiopia though it causes substantial mortality, morbidity, disability, and psychological and economic cost in the country. Moreover, the factors attributed to NTDs were not addressed. Hence, this study intended to identify the determinants of neural tube defects in Amhara Region, Ethiopia. Methods. A case-control study design was conducted among 400 newborns (133 cases and 267 controls) who were born at randomly selected public hospitals. Cases were identified using the physician diagnosis of confirmed NTDs, and the two consecutive controls were selected using a simple random sampling technique. The data analysis was done using Stata 14.0. Variables with value < 0.25 in the bivariate analysis were entered into the multivariable logistic regression model, and a corresponding 95% confidence interval was used to identify the predictors of NTDs. Results. In this study, fifty percent (48%) of the cases were contributed by anencephaly. After controlling the covariates, living in rural areas (: 95% CI 1.02, 3.11), being illiterate (: 95% CI 1.07, 4.61), being female newborn (: 95% CI 1.09, 3.50), having no ANC follow-up (: 95% CI 1.17, 5.04), and having a previous history of NTDs (: 95% CI 2.42, 7.96) were the risk factors for NTDs. However, being supplemented with folic acid or multivitamins before or during pregnancy (: 95% CI 0.21, 0.65), never having taken any substance during pregnancy (: 95% CI 0.21, 0.88), and being free from medical illnesses during pregnancy (: 95% CI 0.11, 0.69) were the protective factors of NTDs. Conclusion. The study revealed different factors associated with NTDs among newborns in the region. Therefore, comprehensive preventive strategies focused on identified risk factors are needed at regional and national levels.