Journal of Tropical Pediatrics - Advance Access

Paediatric Handbook, 8th edn Thomson K., Tey D., Marks M. (eds)

Ebrahim, G. J. — 2009-06-29

The Incidence Rate of Premature Rupture of Membranes and its Influence on Fetal-neonatal Health: A Report From Mainland China

Liu, J., Feng, Z.-C., Wu, J. — 2009-06-19

Premature rupture of membranes (PROM) is a common pregnancy complication and is associated with significant risks of fetal and neonatal morbidity and mortality. However, there is a lack of data concerning PROM in China. We investigated the incidence rate and analysed the influence of PROM on fetal and neonatal health. This used data from five specialist hospitals and one general hospital in mainland China. The total number of deliveries and the number of those complicated by PROM were recorded between January 2003 and December 2007. The time from initiation of PROM until delivery (latent period), the volume of amniotic fluid at delivery, fetal conditions and neonatal clinical conditions were recorded. The results suggest that the incidence of PROM was 19.53% and it could influence various aspects of the health of fetuses and neonates, including platelet parameters, erythrocyte parameters, neonatal jaundice and myocardial injury.

Myocardial Dysfunction in Severe Falciparum Malaria

Kumar, P. P., Kumar, C. D., Shaik, F. A. R., Ghanta, S. B. — 2009-06-12

Severe malaria causes multiorgan dysfunction, which is the predominant reason for mortality in these children. Cardiac enzymes have been elevated and cardiac involvement has been suspected in some of these children, however, clear cut echocardiographic evidence for it was not possible. There were isolated reports of myocardial dysfunction in malaria in adults but none in children. We present two such children with cardiac involvement and myocardial dysfunction.

Subcutaneous Phycomycosis--Fungal Infection Mimicking a Soft Tissue Tumor: A Case Report and Review of Literature

Thotan, S. P., Kumar, V., Gupta, A., Mallya, A., Rao, S. — 2009-06-11

Subcutaneous phycomycosis is a rare fungal infection of the deeper layers of skin. We describe a representative case. A 10-year-old boy presented with a large swelling on the back of 3 months duration. Biopsy of the lesion confirmed the diagnosis of subcutaneous phycomycosis. There was complete resolution of the lesion after treatment with oral potassium iodide for 3 months.

Normal Reference Values for Serum Lipid Levels in Chinese Adolescents Between 12 and 18 Years of Age

Hu, C., Tao, F., Wan, Y., Hao, J., Ye, D. — 2009-06-08

The purpose of this study was to develop representative gender- and age-specific percentile reference data for serum lipids for Chinese adolescents between 12 and 18 years of age. Blood samples were obtained from 2998 boys and 3225 girls in nine provinces from the mainland of China, including rural and urban areas. The data for serum lipid levels, including TC, TG, HDL-C and LDL-C, were calculated and measured between March and June 2008. Gender- and age-specific percentiles of serum lipid levels were calculated. Gender- and age-specific percentile-based reference data for serum lipids is presented for Chinese adolescents for the first time. The 95th percentile for the TC, TG and LDL-C levels was 5.07, 1.90 and 3.32 mmol/l, and the 5th percentile for the HDL-C level was 0.92 mmol/l among all the students. These reference values can be used to plan and implement preventive policies, and to study temporal trends.

Clinical Responses to a Mega-dose of Vitamin D3 in Infants and Toddlers With Vitamin D Deficiency Rickets

2009-06-08

Objectives: Was to investigate the effect of treatment with an IM injection, a mega dose of vitamin D3 (10 000 IU/kg) on the clinical, biochemical and radiological parameters of 40 rachitic children with vitamin D deficiency (VDD) over a period of 3 months.

Design: In this prospective study we evaluated the clinical, biochemical and radiological responses of an IM injection of cholecalciferol (10 000 IU/kg) for 3 months.

Results: At presentation, the most frequent manifestations were enlarged wrist joints, hypotonia, irritability, cranial bossing, wide anterior fontanel, bow legs, delayed teething and walking and Harrison's sulcus with chest rosaries. Short stature (length SDS < –2) was recorded in 30% of patients. Craniotabes and hypocalcemic tetany were the least common presentations. In VDD children the most frequent biochemical abnormality was high alkaline phosphatase (ALP) (100%), followed by low phosphate (PO₄) (75%) and low calcium (Ca) (12.5%). One month after treatment, serum Ca, PO₄ and 25(OH)D concentrations were normal. Three months after the injection, serum level of ALP and parathormone (PTH) decreased to normal. The majority of patients (87.5%) had serum 25(OH)D level ≥ 20 ng/ml, but some (12.5%) had level <20 ng/ml. Hypercalcemia was not recorded in any patient during the 3-month-period. Significant cure of all symptoms and signs related to vitamin D deficiency had been achieved in all children. Leg bowing showed significant improvement in all patients but was still evident in one third. Complete healing of the radiological evidence of rickets was achieved in 95% of all children.

Conclusion: An IM injection of a mega dose of cholecalciferol is a safe and effective therapy for treatment of VDD rickets in infants and toddlers with normalization of all the biochemical parameters and healing of radiological manifestations. Measurement of serum 25(OH)D level is highly recommended in all short children with a clear need for a general vitamin D supplementation for all infants and young children in Qatar.

Vitamin A and Vitamin B-12 Concentrations in Relation to Mortality and Morbidity among Children Born to HIV-Infected Women

2009-06-05

Vitamin A supplementation starting at 6 months of age is an important child survival intervention; however, not much is known about the association between vitamin A status before 6 months and mortality among children born to HIV-infected women. Plasma concentrations of vitamins A and B-12 were available at 6 weeks of age (n = 576 and 529, respectively) for children born to HIV-infected women and they were followed up for morbidity and survival status until 24 months after birth. Children in the highest quartile of vitamin A had a 49% lower risk of death by 24 months of age compared to the lowest quartile (HR: 0.51, 95% CI: 0.29–0.90; P-value for trend = 0.01). Higher vitamin A levels were protective in the sub-groups of HIV-infected and un-infected children but this was statistically significant only in the HIV-uninfected subgroup. Higher vitamin A concentrations in plasma are protective against mortality in children born to HIV-infected women.

Hypokalemic Paralysis Following Severe Vomiting in a Child with Intestinal Obstruction Due to Round Worms

Nagotkar, L., Shanbag, P., Shenoy, P. — 2009-06-05

Ascariasis is one of the most common helminthic infestations in humans. Massive infestation can give rise to serious complications such as intestinal obstruction. We present a 4-year-old boy, who presented with acute flaccid quadriparesis due to the hypokalemic alkalosis induced by severe vomiting. Severe vomiting was due to intestinal obstruction caused by round worms.

High Prevalence of Soil-transmitted Helminths in Western Kenya: Failure to Implement Deworming Guidelines in Rural Nyanza Province

Riesel, J. N., Ochieng', F. O., Wright, P., Vermund, S. H., Davidson, M. — 2009-06-05

Soil-transmitted helminth (STH) infections affect an estimated 2 billion people world wide. Children experience the greatest morbidity, limiting their potential in academic and physical endeavors. Our study assessed the prevalence of STH infections in primary school-aged children in a rural village in the Nyanza Province of Kenya. Over two-thirds (68%) of the sampled population tested positive using a direct smear microscopic analysis of single stool samples. Only heavy worm infections would be detected with this technique; thus 68% is a minimum estimate of prevalence. Prior to our study, there were no deworming programs in this village, despite WHO and Kenyan government guidelines supporting regular deworming programs. Our study demonstrates the significant burden of STH infections in a rural Kenyan village and highlights the need for deworming programs in similar venues. We also demonstrate that with basic infrastructure and community involvement, regular deworming can be implemented effectively in remote, rural communities.

Incidence and Etiology of Neonatal Hyperbilirubinemia

Sarici, S. U. — 2009-06-05

Hypothermia in Children with Severe Malnutrition: Low Prevalence on the Tropical Coast of Kenya

Talbert, A., Atkinson, S., Karisa, J., Ignas, J., Chesaro, C., Maitland, K. — 2009-06-02

Hypothermia is stated as a common complication of severe malnutrition although there are little primary data to support this. We performed a prospective study of children with severe acute malnutrition (SAM) admitted to a district hospital in Kenya. We documented the prevalence of hypothermia and examined its association with outcome and ambient temperature. During a 2-year period 667 children were recruited. Hypothermia was recorded in only 12 out of 15 191 (0.08%) temperature observations and as a single event in 12 children (2% of cases). There was no correlation with ambient temperature. Although mortality rates were higher in children with hypothermia (4/12, 33%) than those without (121/655, 18%), the timing of hypothermia did not coincide with clinical deterioration. Hypothermia was a rare marker of severity in our setting. We recommend that other observations be highlighted to identify high risk groups and that routine temperature observations be reduced wherever staff are few.

Serum Levels of Ghrelin, Tumor Necrosis Factor-{alpha} and Interleukin-6 in Infants and Children with Congenital Heart Disease

Afify, M. F., Mohamed, G. B., El-Maboud, M. A., Abdel-Latif, E. A. — 2009-06-02

Objective: To estimate serum levels of ghrelin, tumor necrosis factor- (TNF-) and interleukin-6 (IL-6) in infants and children with congenital heart disease (CHD), compared with levels in age-matched controls, and to correlate the levels of ghrelin with TNF- and IL-6.

Design: Case–control study.

Setting: Suzan Moubarak Hospital of Al-Minya University, Egypt.

Patients: We measured serum ghrelin, TNF- and IL-6 levels using ELISA in 60 patients with CHD (40 acyanotic and 20 cyanotic) and in 20 control subjects.

Results: Our results showed that patients with CHD, regardless of the presence or absence of cyanosis, had significantly higher serum ghrelin, TNF- and IL-6 than controls (p = 0.000). Serum levels of ghrelin and TNF- in the acyanotic patients were significantly higher than in the cyanotic patients (p = 0.000). On the other hand, there was no significant difference in serum levels of IL-6 between the acyanotic and the cyanotic patients (p = 0.126). In acyanotic and cyanotic patients with CHD, there was a positive correlation between ghrelin and TNF- (r = 0.424; p = 0.006 and r = 0.577; p = 0.008, respectively). Ghrelin levels were not correlated to IL-6 in the acyanotic and cyanotic patients with CHD (r = –0.211; p = 0.216 and r = –0.341; p = 0.08, respectively).

Conclusion: Serum ghrelin, TNF- and IL-6 levels are elevated in patients with CHD whether acyanotic or cyanotic. Increased ghrelin levels represent malnutrition and growth retardation in these patients. The relation of ghrelin with TNF- may be explained by the possible effect of chronic congestive heart failure and chronic shunt hypoxemia.

Nutritional Quality and Osmolality of Home-made Enteral Diets, and Follow-up of Growth of Severely Disabled Children Receiving Home Enteral Nutrition Therapy

Santos, V. F. N., Morais, T. B. — 2009-05-19

This study evaluated the nutritional quality of home-made enteral diets and their effect on growth parameters. Thirty pediatric patients receiving only homemade enteral diets were enrolled. Samples of milk-based (MB) and soup-based (SP) feeds were taken for chemical analises. The chidren's anthropometric indexes were assessed. In the MB, the measured values for the macronutrients and energy corresponded to approximately 70% of the prescribed values. Conversely, the SP measured values corresponded to less than 50% of the prescribed values, except for carbohydrate. The prevalence of underweight was 30% (9/30) at the time of entry into home nutritional therapy and declined to 20% (6/30) at the time of the study (p = 0.007). Stunting increased throughout the follow up, from 30% (9/30) to 53% (16/30; p = 0.511). Obesity prevalence fell from 17% (4/23) to 9% (2/23; p < 0.001). Despite their inconsistent levels of macronutrients and energy, home-made enteral diets had no negative effect on the patients' weights.

Relationship of CD4+ T-cell counts and plasma HIV-1 RNA levels with serological HBeAg/anti-HBe patterns obtained in West-African HBV-HIV-1-co-infected children

2009-05-15

HBeAg/anti-HBe and hepatitis B virus (HBV) DNA from 34 HIV-1-infected children from Ivory Coast with chronic hepatitis B (CHB) were longitudinally analyzed according to CD4 and HIV-1 RNA. The mean CD4% value was significantly (p = 0.03) lower in 59 (52.7%) samples showing a usual CHB (HBeAg-positive/anti-HBe-negative and HBV DNA-positive), as compared with 30 (26.8%) HBeAg-positive/anti-HBe-positive and HBV DNA-positive and 23 (20.5%) HBeAg-negative/anti-HBe-positive and HBV DNA-negative (15.1% vs. 18.5% and 20.0%). The mean HIV-1 RNA concentrations were significantly (p = 0.01) higher in specimens HBV DNA-positive (4.47 and 4.30 log₁₀/ml, respectively) vs. HBV DNA-negative (3.43 log₁₀/ml). HIV-1 has a significant impact on CHB acquired in childhood.

Assessment of nutritional status in the Amazigh children of Amizmiz (Azgour Valley, High Atlas and Morocco)

2009-05-15

The Berbers of the High Atlas (Amazigh) live in very severe socio-economic and climatic conditions, which expose children to the risk of malnutrition. In this study we used anthropometry and bioelectrical impedance analysis for the assessment of nutritional status. Height, weight and bioelectrical parameters were taken on 71 children (28 boys and 43 girls). Height and BMI were standardized using the 2007 WHO reference. The results show that 36.6% of the children were classified as stunted and 8.5% as wasted. Based on the Bioelectrical Impedance Vector Analysis, children from the High Atlas had an adequate body cell mass, but a high risk of dehydration (42.3%).

Dose-dependent effect of Lactobacillus rhamnosus on quantitative reduction of faecal rotavirus shedding in children

Fang, S.-B., Lee, H.-C., Hu, J.-J., Hou, S.-Y., Liu, H.-L., Fang, H.-W. — 2009-05-12

Beneficial effects of probiotics in acute infectious diarrhoea in children are mainly seen in watery diarrhoea and viral gastroenteritis. Lactobacillus rhamnosus, one the most extensively studied probiotic strains, is effective in shortening courses of acute diarrhoea in children. However, the dose-dependent effect of Lactobacillus upon quantification of faecal rotavirus shedding in humans remains little known. Thus, an open-label randomized trial in 23 children with acute rotaviral gastroenteritis was undertaken by randomly allocating patients to receive one of the three regimens for 3 days: daily Lactobacillus rhamnosus 35 (Lcr35) with 0 CFU/day to six patients in the control group, 2 x 10⁸ CFU/day to nine patients in the low-dose group, and 6 x 10⁸ CFU/day to eight patients in the high-dose group. Faecal samples were collected before and after the 3-day regimen for measurements of rotavirus concentrations by ELISA. There was no statistically significant change in faecal rotavirus concentrations in either the control group (119.2 x 10⁵ particles/ml vs. 23.7 x 10⁵ particles/ml, p = 0.075) or the low-dose group (36.1 x 10⁵ particles/ml vs. 73.5 x 10⁵ particles/ml, p = 0.859). However, the high-dose group had a significant reduction of faecal rotavirus concentration (64.2 x 10⁵ particles/ml vs. 9.0 x 10⁵ particles/ml, p = 0.012). Without any exception, the faecal rotavirus concentrations of all eight patients in the high-dose Lcr35 group declined by 86% after 3 days when compared with those before Lcr35 administration. In conclusion, this is the first report to provide quantitative evidence of the dose-dependent effect of Lactobacillus rhamnosus, a minimal effective dose of 6 x 10⁸ CFU for 3 days, upon the faecal rotavirus shedding in paediatric patients.

Screening of 18-24-Month-Old Children for Autism in a Semi-Urban Community in Sri Lanka

Perera, H., Wijewardena, K., Aluthwelage, R. — 2009-04-28

All children aged 18–24 months in a defined geographical area were initially screened for autism, using ‘Red Flag’ criteria. All the children with one or more positive ‘Red Flag’ signs were further screened using Modified Checklist for Autism in Toddlers (M-CHAT) translated to Sinhala, followed by a comprehensive clinical assessment. Of a sample of 374 children, ‘Red Flag’ signs were positive in 28 (7.4%). Four children received a diagnosis of autism on clinical assessment giving a prevalence of 1.07% or 1 per 93 in the 18–24-month age group. Sensitivity of M-CHAT was only 25%, and specificity 70%. The high prevalence detected strongly justifies early community-based screening, but a culturally sensitive screening tool needs to be developed for Sri Lanka.

Severe Pneumonia in Mozambican Young Children: Clinical and Radiological Characteristics and Risk Factors

2009-04-28

Background: Pneumonia is a leading cause of hospitalization and death among children in Africa. We describe the clinical presentation of severe pneumonia among hospitalized children in a malaria endemic area with a high prevalence of HIV infection. Methods: As part of a 2-year prospective study of radiologically confirmed pneumonia, chest radiographs, malaria parasite counts and bacterial blood cultures were systematically performed for children 0–23 months admitted with severe pneumonia. Radiographs were interpreted according to WHO guidelines. HIV tests were performed during a 12-month period. Results: Severe pneumonia accounted for 16% of 4838 hospital admissions among children 0–23 months; 43% of episodes had endpoint consolidation, 15% were associated with bacteremia and 11% were fatal. Fever, cough >3 days, crepitations, hypoxemia and absence of malaria parasitemia were associated with radiologically confirmed pneumonia. Nineteen per cent of children with severe pneumonia and 27% with radiologically confirmed pneumonia had clinical malaria. HIV-prevalence was 26% among children hospitalized with severe pneumonia and HIV-testing results. HIV infection, anaemia, malnutrition, hypoxemia and bacteremia were associated with fatal episodes of severe pneumonia. Conclusion: Treatment of admitted children with severe pneumonia is complicated in settings with prevalent HIV and malaria. Children with severe pneumonia and clinical malaria require antibiotic and antimalarial treatment. In addition to vertical programs, integrated approaches may greatly contribute to reduction of pneumonia-related mortality.

Coagulation Status and Platelet Functions in Children with Severe Falciparum Malaria and their Correlation of Outcome

Prasad, R., Das, B. K., Pengoria, R., Mishra, O. P., Shukla, J., Singh, T. B. — 2009-04-28

This study was undertaken to observe the changes in coagulation and platelet profile, and findings were correlated with their outcome. Forty consecutive children with severe falciparum malaria were studied for their coagulation status, i.e. prothrombin time (PT), activated thromboplastin time (APTT), thrombin time (TT) and anti-thrombin-III (AT-III), platelet profile (platelet count, platelet aggregation with adenine diphosphate (ADP) and ADR and PF3 availability). Derangements in the coagulation profile in the form of increased PT, APTT and/or TT were seen in 47.5, 35 and 62.5% cases, respectively, but bleeding was seen in only six cases. Thrombocytopenia was found in 34 patients. Platelet aggregation with ADP and ADR revealed hypoaggregation in 95.3 and 97.5% cases, respectively, and were statistically significant. Platelet factor-3 availability was also significantly prolonged. Patients with prolonged PT, PF-3 and hypoaggregation with adrenaline had 1.4, 1.7 and 1.45 times higher risk of mortality.

Human Bocavirus in Very Young Infants Hospitalized with Acute Respiratory Infection in Northeast Brazil

2009-04-28

A cross-sectional study was carried out over a period of 12 months to investigate the occurrence of human bocavirus (HBoV) infection in infants hospitalized for respiratory infections in a teaching hospital in Salvador, Brazil, and to describe the clinical manifestations of this infection. Nasopharyngeal aspirates were collected from the children and immunofluorescence and polymerase chain reaction were performed to investigate the presence of respiratory viruses. HBoV was detected in 4 out of 66 patients. Two of the HBoV-positive infants were co-infected with other viruses. The principal clinical findings in HBoV-positive children were: nasal obstruction, catarrh, cough, fever and dyspnea. This study revealed HBoV infection in children aged <2 months, suggesting that the infection may occur at a very early age.

Comparison of the Use of Liquid Crystal Thermometers with Glass Mercury Thermometers in Febrile Children in a Children's Ward at Port Moresby General Hospital, Papua New Guinea

Mauta, L., Vince, J., Ripa, P. — 2009-04-24

We compared the temperatures recorded, in febrile children admitted to a children's ward at Port Moresby General Hospital, by a doctor and by a group of nurses using glass mercury thermometers (GMT) and liquid crystal thermometers (LCT, Nextemp^R and Traxit^R). The mean difference (with 95% confidence intervals) in temperatures between GMT and Nextemp^R were –0.12°C (–0.16°C to –0.08°C) for the doctor and 0.12°C (0.04–0.20°C) for nurses. The mean difference in temperatures between GMT and Traxit^R were –0.05°C (–0.09°C to –0.01°C) for the doctor and 0.19°C (0.10–0.28°C) for the nurses. A similar result was obtained when one of the Nextemp^R thermometers used in the initial study was compared with GMT on a small sample of patients by the doctor 8 months later. Limited evaluation showed nursing staff were in favour of using the LCTs. Nextemp^R and Traxit^R thermometers can be used interchangeably with GMT in this setting.

Subtyping and env C2/V3 Sequence Analysis of HIV-1 Isolated from HIV-Infected Children Hospitalized in Children Hospital 1, Vietnam during 2004-2005

2009-04-20

A molecular epidemiological study was conducted on 104 HIV-1 strains isolated from HIV-infected children hospitalized in Children Hospital 1 in Ho Chi Minh City, Vietnam during 2004–2005. Genetic subtyping based on env C2/V3 sequences revealed that CRF01-AE was the sole circulating recombinant form found in this study. Sequence analysis of the V3 loop showed that GPGQ tetramer was the most common V3 loop core motif identified in the HIV-1 strains studied (89.5%). The findings raise great concern about HIV-infected children in Vietnam and provide up-to-date molecular epidemiological information of HIV-1 circulating in Vietnam during the study period.

Oxidative Stress and Antioxidant Status in Neonates Born to Pre-eclamptic Mother

Howlader, Md. Z. H., Parveen, S., Tamanna, S., Khan, T. A., Begum, F. — 2009-04-20

Objective: Pre-eclampsia is a significant health problem and is the leading cause of maternal and perinatal mortality and morbidity. Low birth weight and prematurity are very common in pre-eclamptic mothers. Pre-eclampsia is associated with oxidative stress in the maternal circulation. To observe the effect of pre-eclampsia on neonates, this study was designed to explore oxidative stress and anti-oxidant status in the fetal circulation in pre-eclampsia.

Materials and Methods: For this purpose, we collected cord bloods during delivery from Bangabandhu Sheikh Mujib Medical University. Twenty samples were collected from uncomplicated (normotensive) mothers and 15 samples were collected from pre-eclamptic mothers (maternal age matched). Thiobarbituric acid reactive substances (TBARS), lipid hydroperoxide, protein carbonyl value, lipid profile, total anti-oxidant status (TAS), vitamin C, serum total protein and albumin were measured.

Results: It was observed that TBARS and lipid hydroperoxide were significantly (P < 0.001) increased, protein carbonyl content were also significantly (P < 0.001) increased but total anti-oxidant status (P < 0.001) and vitamin C level were significantly (P < 0.05) decreased in cord blood from pre-eclamptic mother compared to control group. Cholesterol, TG, LDL level was elevated and HDL were lowered in cord blood in pre-eclamptic group compared to normotensive group. In pre-eclamptic group, cord blood total protein, albumin and globulin level were significantly decreased compared to control group.

Conclusions: As pre-eclampsia is associated with increased oxidative stress and decreased anti-oxidant status, the results of these investigations suggest that oxidative stress and antioxidant status are altered towards proatherogenic level in cord blood of pre-eclamptic women which may ultimately be responsible for different complications of newborn babies of pre-eclamptic mothers.

A Cross-sectional Study of the Growth Characteristics of Nigerian Infants from Birth to 2 Years of Age

VanderJagt, D. J., Waymire, L., Obadofin, M. O., Marjon, N., Glew, R. H. — 2009-04-16

Malnutrition compromises the growth of children in sub-Saharan Africa. In Nigeria, the prevalence of childhood malnutrition approaches 40%. There are few reports relating the growth characteristics of breast-fed Nigerian infants to the anthropometric properties of their mothers. A total of 100 urban and rural mother/baby pairs were recruited. The mean BMI values of the urban and rural mothers were 24.2 and 21.3 kg m^–2, respectively. The mean length, weight and head circumference of the rural infants were significantly lower than those of the urban infants. Z-scores based on World Health Organization standards showed: (i) length-for-age z-score <–2 in urban (27%) and rural (33%) children; (ii) a higher incidence of underweight and small HC in rural (33%; and 13%) versus urban children (12% and 0%); and (iii) positive correlations between all three z-scores and maternal BMI. Negative correlations were observed between infant age and z-scores for length-for-age, weight-for-age and HC-for-age.

Hypercalcemia due to Hypervitaminosis D: Report of Seven Patients

Joshi, R. — 2009-04-01

We retrospectively studied seven children (six girls, one boy) aged from 7.5 to 25 months who presented to our institution after taking large doses of vitamin D (900 000–4 000 000 U) prescribed by medical practitioners for wrong indications like failure to thrive, etc. The clinical manifestations were constipation, decreased appetite, lethargy, polyuria, dehydration and failure to thrive. All patients had hypercalcemia (serum calcium ranging from 12 to 16.8 mg/dl), high 25[OH]D levels (ranging from 96 to >150 ng/ml), suppressed intact parathyroid hormone (ranging from <3 to 8.1 pg/ml). Hypercalciuria (urinary calcium/creatinine ranging from 1 to 2.45) was found in all patients, while nephrocalcinosis was present in five patients. All were treated with intravenous fluids, oral prednisolone, restriction of calcium in diet, while four patients received pamidronate infusion for reducing hypercalcemia.

Rotavirus Infections among HIV-Infected Children in Nairobi, Kenya

2009-03-18

Human rotaviruses have emerged as a leading cause of acute diarrhea in children <5 years of age worldwide. Although there are previous reports relating to various aspects of rotaviruses, there is limited data on the involvement of rotavirus infection in HIV-infected children. We therefore evaluated the importance of rotavirus infections in HIV-related diarrhea in Kenyan children. Fecal samples were collected from a total of 207 children during the period February 1999 to June 2000 and screened for HRV antigen by enzyme-linked immunosorbent assay (ELISA). Positive samples were analyzed by VP6 subgroup specificity assay, by polyacrylamide gel electrophoresis (PAGE) and reverse transcriptase/polymerase chain reaction (RT–PCR). Fourteen percent (29/207) of the samples were positive. HIV-seropositive children with diarrhea were more likely than their counterparts without diarrhea to have rotaviruses [23.3% (10/43) versus 2.9% (2/70); p = 0.0001]. Rotavirus strain G3P[6] was predominant. These results indicate that rotavirus is an important viral etiological agent causing diarrhea in HIV-seropositive children.

The Relationship of Body Mass Index and Blood Pressure in Iranian Children <7 Years Old

Ataei, N., Hosseini, M., Iranmanesh, M. — 2009-03-18

The objective of this study was to evaluate the association between the body mass index (BMI), in healthy young children with their blood pressure (BP). The study included 3186 healthy children aged 1–6 years who were studied between March 2004 and March 2007 in different kindergartens and health centers in Tehran. Each child was classified on the basis of age- and sex-specific BMI percentile as normal weight (BMI <85th percentile), at risk for overweight (BMI >85th and <95th percentile), or overweight (BMI ≥95th percentile). Systolic BP (SBP) and diastolic BP (DBP) was compared among age–sex–BMI groups. Among children aged below 7 years in kindergartens and health centers in Tehran, 7.2% were at risk of overweight and 12.2% were overweight. These proportions were similar for boys and girls and were as follows: 6.9%, 13.9% and 7.5%, 10.5%, respectively. Analysis of variance showed that mean SBP significantly increased according to age (p < 0.0001) and BMI group (p = 0.001). Analysis of variance also showed that mean DBP significantly increased as age increased (p < 0.0001), but no significant difference was found between boys and girls in different age and BMI groups (p = 0.37). Our survey identified a high prevalence of overweight that was associated with elevated SBP among preschool-aged children in Iran. The effect of higher BMI on mean SBP is present in childhood and can be used as a predictor of high SBP even in children as young as 1–6 years.

A Study of Profile of Ventilator-associated Pneumonia in Children in Punjab

Sharma, H., Singh, D., Pooni, P., Mohan, U. — 2009-03-17

Objectives: To determine incidence, related factors, outcome, bacterial organisms and their sensitivity patterns with regard to ventilator-associated pneumonia (VAP) in children.

Setting: Level III PICU of a tertiary care center.

Design: Prospective cohort study.

Methods: Children in the age group of 1 month to 15 years, admitted to the pediatric intensive care unit requiring ventilatory support (V.I.P.BIRD infant-Pediatric ventilator) for at least 48 h. Clinical criteria used to define VAPs were the same as used by and Elward et al. and Salata et al.

Results: Forty patients met the inclusion criteria and 8 (20%) had VAP. The risk factor significantly related with development of VAP was the use of H₂ blockers (Ranitidine) for >2 days. All other related factors were not significantly related to occurrence of VAP.

Conclusion: Use of H₂ blockers (Ranitidne) is associated with higher incidence of VAP in children.

An Unusual Cause of Gastrointestinal Bleeding and Severe Anemia in a Child: Leech Infestation

Taskesen, M., Katar, S., Bascik, H. — 2009-03-05

A 1-year-old boy with epistaxis, gastrointestinal bleeding and severe anemia that caused cardiorespiratory distress presented to our unit. The results of coagulation tests were normal. An erythrocyte suspension transfusion was given to the patient. On the second day of his hospitalization, a leech was removed from his nose. In developing countries, leech infestation should be considered in cases where epistaxis, hematemesis, gastrointestinal bleeding and severe anemia are of unknown origin.

Randomized Clinical Trial Comparing Hepatitis B Vaccine Administered by 0, 6 and 14 Week versus 6, 10 and 14 Week Schedule in Healthy Infants

Das, R. R., Mathew, J. L., Ratho, R. K., Dutta, S. — 2009-03-05

Objective: This randomized, single-blinded trial was carried out to compare the sero-efficacy of hepatitis B vaccine administered to healthy infants by either of two schedules–birth, 6, 14 weeks or 6, 10 and 14 weeks.

Methods: The 74 infants born to HbsAg-negative mothers were randomized to receive recombinant hepatitis B vaccine at 0, 6 and 14 weeks (Group A) or 6, 10 and 14 weeks (Group B). Serum anti-HBs antibody titer was measured before the first dose and 6 months after the third dose by laboratory personnel blinded to the intervention. All participants received other vaccines as per the national immunization schedule.

Results: At 6 months after the third dose sero-conversion was 100% in both groups. A total of 97.3% of subjects in Group A were sero protected (>10 mIUml^–1) with geometric mean titer (GMT) of 113.78 mIUml^–1 and 94.6% in Group B (GMT 107.04 mIUml^–1) [p = 0.8].

Conclusion: Hepatitis B vaccination by 0, 6 and 14 weeks and 6, 10 and 14 weeks schedules are comparable in terms of sero-efficacy.

Ghrelin Levels in Children with Congenital Heart Disease

Kandil, M. E., Elwan, A., Hussein, Y., Kandeel, W., Rasheed, M. — 2009-03-04

Background: Ghrelin is a novel growth hormone-releasing peptide that causes a positive energy balance by stimulating food intake and inducing adiposity and has effects on growth. Many children with congenital heart disease (CHD) present with growth retardation and malnutrition owing to multifactorial reasons.

Aim: To evaluate the circulating level of ghrelin in Egyptian children with congenital cyanotic and acyanotic heart disease and its relation to anthropometric measurements.

Materials and methods: The study included 40 patients with cyanotic and acyanotic CHD (18 cyanotic and 22 acyanotic) and 18 age- and sex-matched healthy control children. All children were subjected to measurement of height, weight, body mass index (BMI) and serum ghrelin was measured using ELISA technique.

Results: Weight, height and BMI were significantly lower in cyanotic and acyanotic patients compared to the control group (p = 0.0001). Serum ghrelin levels were significantly higher in children with cyanotic and acyanotic CHD in comparison to the controls (p = 0.0001). There was a significant negative correlation between ghrelin and BMI in the three groups (r = –0.534, p = 0.023; r = –0.558, p = 0.007; r = –0.608, p = 0.007 respectively for cyanotic, acyanotic and the control groups).

Conclusion: Circulating ghrelin level was elevated in children with congenital cyanotic and acyanotic heart disease, and was associated with a decrease in BMI. This elevation in ghrelin level may represent malnutrition and growth retardation in those patients as obvious by anthropometric measures too. This may suggest that ghrelin may have an important role as a compensatory mechanism in the regulation of the metabolic balance in them.

Linear Growth in Children with Iron Deficiency Anemia Before and After Treatment

2009-03-04

We measured growth [length (L) standard deviation score (SDS), growth velocity (GV) SDS and body mass index (BMI)] and hematological (hemoglobin, hematocrit, MCV and MCH) parameters in 40 children (aged 17.2 ± 12.4 months) with iron deficiency anemia (IDA) before and after iron therapy. Before treatment children with IDA had LSDS = –1.2 ± 1, GV = 7.5 ± 2.2, GVSDS = –1.42 ± 0.6 and BMI = 13.5 ± 1.2. They were significantly shorter and had reduced growth as compared with age-matched controls. After treatment, their growth parameters significantly increased with LSDS = –0.6 ± –0.9, GV = 13.2 ± 4.4 cm year^–1, GVSDS = 1.7 ± 0.5 and BMI = 14.2 ± 1.1. Their GV correlated significantly with serum ferritin concentration (r = 0.48, p < 0.001) and BMI (r = 0.32, p < 0.1). In summary, IDA during the first 2 years of life significantly impairs growth.

Endomyocardial Fibrosis: An Under-diagnosed Cause of Cardiomyopathy in Sudanese Children

Ali, S. K. M. — 2009-03-04

Endomyocardial fibrosis (EMF) is a tropical cardiomyopathy reported in many tropical countries. Patients were seen at the Children's Hospital-Khartoum, Sudan during September 2007–08 where cardiac evaluation was done. Six patients were identified (18% of all children with cardiomyopathy); all were males aged 8–17 years. All patients presented with abdominal distention, stunted growth, raised jugular venous pressure, ascites and hepatosplenomegaly. Electrocardiogram abnormalities included atrial fibrillation, first and third degree AV block and tall P wave. Echocardiography revealed huge right atrium dilatation and right ventricle apex obliteration by fibrous tissue. One patient had left-side affection with moderate mitral regurgitation. Eosinophilia was present in three patients. Two patients received antituberculosis drugs with no improvement, two had history of treated bilharziasis and two had been labeled as having Ebstein disease. EMF is an important cause of cardiomyopathy in Sudan that is often misdiagnosed. Clinical and echocardiographic examinations can lead to the correct diagnosis.

Linear Growth in Relation to the Circulating Concentration of Insulin-like Growth Factor-I and Free Thyroxine in Infants and Children with Congenital Cyanotic Heart Disease Before vs. After Surgical Intervention

El-Sisi, A., Khella, A., Numan, M., Dilwar, M., Bhat, A., Soliman, A. — 2009-03-01

This prospective controlled study recorded the anthropometric data and measured the circulating insulin-like growth factor-I (IGF-I) in 16 children with congenital cyanotic heart disease before and a year after surgical intervention. At presentation patients were significantly shorter [length SD scores (LSDS) = –2.44 ± 1.31], vs. controls (LSDS = –0.25 ± 0.18). After surgical treatment the LSDS and growth velocity SD scores (GVSDS) increased significantly to (–) 0.25 ± 0.95 and 3.7 ± 2.1, respectively. IGF-I increased from 45.7 ± 26.3 ng ml^–1 to 67.7 ± 16.4 ng ml^–1. The GVSDS after treatment was correlated with the body mass index (BMI) (r = 0.339, p < 0.05) and negatively with the LSDS before surgery (r = –0.461, p < 0.05). The percentage increase of IGF-I after operation was correlated significantly with the BMI after surgical intervention (r = 0.82, p < 0.001). It appears that the postoperative growth spurt in infants with cyanotic congenital heart disease (CHD) is mediated through activation of the GH/IGF-I system and improved nutrition.

Fluid Needs for Children Made Easy:Simple Formulae for Calculating the Fluid Needs of Children

Dugdale, A. — 2009-02-20

Safety, Effectiveness and Barriers to Follow-up Using an 'Early Discharge' Kangaroo Care Policy in a Resource Poor Setting

Blencowe, H., Kerac, M., Molyneux, E. — 2009-02-10

Aim: To describe the outcomes of low-birth-weight babies using an ‘early discharge’ Kangaroo care policy and to identify barriers to their follow-up.

Methods: Prospective descriptive study of all 272 babies admitted to a Kangaroo Care Ward in Malawi from November 2003 to May 2004. Infants were discharged to outpatient care once weighing over 1300 g and gaining weight. Follow-up was carried out until 2500 g.

Results: Infants [201 of 272 (73.9%)] reached a weight >2500 g; 46 out of 272 (16.9%) died; outcome was unknown in 25 of 272 (9.2%). Outpatient mortality was higher amongst discharges weighing under 1500 g [RR = 2.41(1.25–4.63) P = 0.01]. Discharge below birth weight did not affect mortality [RR = 0.77(0.40–1.46) P = 0.42]. Barriers identified to seeking healthcare post-discharge included transport problems and late recognition of illness.

Conclusions: Early discharge is safe and feasible, but issues regarding access to healthcare need to be addressed. Future research is needed to determine how best high mortality can be reduced in specific subgroups: notably infants <1500 g.

Mycoplasma pneumoniae--Associated Cerebral Infarction in a Child

Lee, C.-Y., Huang, Y.-Y., Huang, F.-L., Liu, F.-C., Chen, P.-Y. — 2009-02-10

The central nervous system's involvement is the most common reported extra-pulmonary manifestations of Mycoplasma pneumoniae infection, and stroke was one of the most special situations. We presented a 4-year-old child who presented with acute stroke on the third day of the onset of Mycoplasma respiratory tract infection. Brain magnetic resonance angiography demonstrated that occlusion of bilateral internal carotid arteries and vertebral arteries above the level of the first cervical vertebrate which is not been reported previously.

Parvovirus B19-induced Thrombocytopenia and Anemia in a Child with Fatal Fulminant Hepatic Failure Coinfected with Hepatitis A and E Viruses

Kishore, J., Sen, M. — 2009-02-08

A 5-year-old male, drowsy, jaundiced child presented with fulminant hepatitis and had HAV and HEV infection. He had hepatic encephalopathy grade 1, fever, pallor, hypotension, crepitations in his right lung base and hepatosplenomegaly with dyspnoea. He had highly raised liver enzymes and hypoalbuminemia (2.8 g/dl) but anemia (hemoglobin of 7.7 g/dl and 5.7 g/dl 2 days later), reticulocytopenia and severe thrombocytopenia (44 x 10⁹/l) were unexplained. Parvovirus B19-specific IgM antibodies and B19 DNA were found in the serum of the child. Chest X-ray showed pleural effusion and bronchopneumonia, while blood culture isolated coagulase-negative staphylococci (BACTEC 9120) and he had low oxygen saturation. Hence, he was treated with IV amoxicillin+ clavulinic acid and oxygen inhalation. He had seizures and cardiac arrest but was revived. On the third day his condition worsened and the child died despite intensive care. Hence it is concluded that his anemia and thrombocytopenia were B19 induced and this might have aggravated or caused fulminant hepatitis.

Optimization Strategy to Minimize Wastage of Palivizumab during the 2008 RSV Season in Sao Paulo, Brazil

2009-02-08

Palivizumab is currently recommended to high-risk children as a prophylaxis for respiratory syncytial virus (RSV) infection. However, it is still very expensive for developing countries like Brazil. Herein, we describe our strategy to minimize wastage of Palivizumab during the 2008 RSV season. Appointments were fixed for 304 children on 2 days of the week, so that a mean of 19.9 children received Palivizumab per day. That allowed remaining volumes of Palivizumab vials to be pooled and used for other children on the same day within the 6 h period after opening a vial. That strategy saved 26.3% of vials, which represents USD749 143.75.

Prevalence of Thinness and Overweight Among Urban Adolescents of West Bengal, India

Ghosh, J. R., Bandyopadhyay, A. R. — 2009-02-08

Patterns and Predictors of CD4 T-cell Counts Among Children Born to HIV-infected Women in Tanzania

Kupka, R., Msamanga, G. I., Aboud, S., Manji, K. P., Duggan, C., Fawzi, W. W. — 2009-01-21

We assessed age-specific CD4 T-cell counts and their determinants among Tanzanian children born to HIV-infected mothers to address a major research gap. A total of 474 HIV-uninfected and 69 HIV-infected children were followed until age of 12 months. Maternal predictors were measured during pregnancy and child predictors at birth and throughout the follow up. Child CD4 T-cell counts were evaluated at the age of 3 months and subsequent 3-month intervals; they decreased linearly among HIV-infected (β = –8 cells per week; 95% CI –12 to –4; P = 0.0003) and increased linearly among HIV-uninfected children (β = 4 cells/week; 95% CI 2–7; P = 0.0008). Decreased child counts were predicted by low child anthropometry, maternal HIV stage ≥2, and maternal mid-upper arm circumference <27 cm among HIV-infected children; and by weight-for-height <–2 z-score, maternal HIV stage ≥2, maternal erythrocyte sedimentation rate <81 mm/h and maternal haemoglobin <8.5 g/dl among HIV-uninfected children. The maternal and child predictors described may serve as intervention targets among HIV-exposed children.

Endoscopy Findings in HIV-Infected Children from Sub-Saharan Africa

Cooke, M. L., Goddard, E. A., Brown, R. A. — 2009-01-15

Background: The causes of persistent gastro-intestinal symptoms in HIV-infected children from sub-Saharan Africa remain poorly documented.

Methods: The clinical, radiological and endoscopic findings of all HIV-infected children who underwent upper GI endoscopy at Red Cross Children's Hospital, Cape Town, South Africa, from February 2003 to October 2005 were documented.

Results: Twenty-six HIV-infected children underwent endoscopy; median age 1 year (range: 0.17–10.9 years). The majority had advanced HIV disease; 18 (69%) were WHO Stage 4; median CD4 10.7% (range: 1–39.8%). Presenting symptoms included persistent vomiting (18), dysphagia (4) and GIT bleed (6). Observational and histological findings showed poor correlation. Pathogens were identified in 10 children: cytomegalovirus infection in seven (two with cryptosporidium co-infection), Candida in two, Helicobacter pylori in one. Age and CD4 count were not associated with the pathogens. Endoscopy findings influenced clinical management in 21 (81%) cases.

Conclusion: Upper-GI endoscopy identified a diverse spectrum of disease and provided information that would be clinically relevant to most HIV-infected children with upper gastro-intestinal symptoms.

Lymphadenovarix of the Head-Neck region--A Rare Presentation of Bancroftian Filariasis

Dwivedi, R. C., Gupta, P., Dwivedi, R. C., Kishore, K., Bhatia, N. — 2008-12-18

Cystic swellings of the neck in children have limited differential diagnoses, often either lymphatic or vascular malformations. Other cystic inflammations can be the result of tuberculous abscesses, suppurated lymph nodes and actinomycosis. Microfilaria causing lmphadenovarix of head–neck region has not yet been described in the literature. A 10-year-old Indian boy presented with an asymptomatic cystic neck mass of 8 months duration. Aspiration of the swelling demonstrated numerous Wuchereria bancrofti microfilaria and the patient responded well to 6 weeks of daily anti-filarial treatment using diethylcarbamazine citrate (6mg kg^–1 day^–1). This appears to be the first report of microfilariae-associated lymphadenovarix of head–neck region. Though rare, filariasis should be considered as a differential diagnosis for aberrant swellings where lymphatic filarids are endemic.

Clinical Notations on Bacteremic Cavitating Pneumococcal Pneumonia in Nonvaccinated Immunocompetent Children

2008-12-14

We describe 10 children who developed lung cavitation during the treatment of bacteremic pneumococcal lobar pneumonia. Chest CT scan showed extensive consolidation with several small lucencies and air-filled cavities. Invasive procedures like aggressive pleural intervention were not needed and the children recovered attaining normal lung function on long-term follow-up.

The Economic Burden of Preterm/Very Low Birth Weight Care in Nigeria

Tongo, O. O., Orimadegun, A. E., Ajayi, S. O., Akinyinka, O. O. — 2008-12-09

The care of very low birth weight (VLBW) neonates may impose an enormous burden on professional resources and finances of caregivers. This study seeks to evaluate the immediate cost of care of VLBW babies in a developing economy. Twenty-four hospital case records VLBW babies who survived till discharge over a 1 year period at the University College Hospital, Ibadan, Nigeria were reviewed. Estimates of the out of pocket costs of managing these babies were calculated. The overall cost of hospital care ranged from US$211.1 to US$1573.9. The direct (median) and indirect (median) cost of care ranged from US$80 to US$1055 (US$247.3) and US$101.0 to US$1128.1 (US$257.2), respectively. These constituted 22.8% and 3966.3% (median 133.4%) of the combined family income. In conclusion, the cost of care of the VLBW deliveries in Nigeria is very high for the level of the economy and constitutes a major financial burden on the family.

Evidence-based Emergency Care: Diagnostic Testing and Clinical Decision Rules Pines J. M. and Everett W. W.

Ebrahim, G. J. — 2008-11-25

Medical Statistics from Scratch, 2nd Edition David Bowers

Ebrahim, G. J. — 2008-11-13

A Succesful Treatment of Avian Influenza Infection in Turkey

Dogan, N., Ozkan, B., Boga, I., Kizilkaya, M., Altindag, H. — 2008-11-13

Avian influenza is a disease characterized with severe pneumonia caused by virus influenza A. Birds and poultry are vectors for spread of this disease. It is diagnosed by clinical evidence and reverse transcription-polymerase chain reaction. Here, we discuss the treatment procedures of a child diagnosed as avian influenza.

Medical Microbiology for the New Curriculum: A Case-Based Approach, Carey R. B., Schuster M. and McGowan K. L.

Ebrahim, G. J. — 2008-09-27

Two Doses of Measles Vaccine: Are Some States in India Ready for It?

John, S., Sanghi, S., Prasad, S., Bose, A., George, K. — 2008-09-17

We present the results of two surveys of measles outbreaks near Vellore, which perhaps supports the cause for introduction of a second dose of measles vaccine. Survey one had 590 under 10-year olds. The attack rate was 15.1, 11.7 and 5.7% in the unimmunized, among those vaccinated at 6 months and at 9 months, respectively. The overall vaccine efficacy (VE) was 28% if vaccinated at 6 months and 66% if at 9 months. Second survey had 1702 children and adolescents. There were 59 cases of measles of which 49 were over 5 years of age, the mean age being 8.8 years. The VE was 66% for children up to 6 years and 48.4% for those aged 7–15. The data suggests that measles vaccine is better given at 9 months. The low VE in school age children could be improved by introducing a second dose of measles vaccine.

Cytokine Profiles in Peripheral, Placental and Cord Blood in an Area of Unstable Malaria Transmission in Eastern Sudan

2008-07-09

Background: Understanding the cytokine interactions that underlie both control and disease should be helpful when investigating the pathogenesis of malaria during pregnancy. Few data exists concerning pathogenesis of malaria during pregnancy in areas of unstable malaria transmission. Objectives: The study was conducted in New Halfa hospital, eastern Sudan, which is characterized by unstable malaria transmission to investigate the cytokine profiles in peripheral, placental and cord blood in parturient women. Methods: Enzyme-linked immunosorbent assay was used to measure the concentrations of three cytokines, interferon- (IFN-), interleukin-4 (IL-4) and IL-10, in sera from peripheral, placental and cord blood of 87 Sudanese women. Results: The concentrations of these cytokines were significantly higher in peripheral, placental sera from uninfected women than in sera from infected women. IFN- concentrations were significantly lower in the cord sera from uninfected women in comparison to the infected ones. The levels of these cytokines were not significantly different between the primiparae and multipare. Cord sera in all groups showed lower levels of these cytokines. Strong positive correlations were observed between peripheral and placental cytokines. Conclusion: The immune responses that occur in placental, peripheral and cord blood were influenced by the malaria infections, irrespective of the parity. The immune response during Plasmodium falciparum infection is not different in the peripheral and placental compartments, further studies are required.

A Novel Mutation in the SLC19A2 Gene in a Turkish Female with Thiamine-responsive Megaloblastic Anemia Syndrome

2008-07-09

Reported here is a 2-year-old girl who was diagnosed to have thiamine-responsive megaloblastic anemia during evaluations for her bilateral neurosensorial deafness. Besides reporting a new mutation on the gene SLC19A2 for the first time in the literature, we highlight the recognition of this syndrome—when megaloblastic anemia and diabetes mellitus coexists—and the role of thiamine replacement for the treatment of both disorders.

Efficacy of Antiretroviral Therapy Program in Children in India: Prognostic Factors and Survival Analysis

2008-06-03

The objective of this article is to study the survival pattern and the prognostic factors for HIV-infected children on antiretroviral therapy (ART) for two and half years at the Government Hospital of Thoracic Medicine, Tambaram, Chennai, India. We studied 295 children who were initiated on ART from 1 April 2004 to 30 September 2006 at a large, public tertiary care facility in Chennai, India. Weight for age Z-score was calculated. Survival curves and Cox proportional hazard models were used to identify risk factors for mortality. The mean and median follow up was 11 and 10 months, respectively. The cumulative survival probability at 6, 12, 18, 24 and 30 months was 93, 90, 89.7, 89.7 and 89.7%, respectively. Of the children who died, about 50% died within the first month. Nearly 6% of the children had adherence less than 95%. The children who had a baseline CD4 percent less than or equal to 14% had significantly (p < 0.05) higher mortality as compared to children who had 20% or more. The children who had negative or no change in weight for age Z-score and hemoglobin had 18.9 (3.7–95.7) times significantly higher mortality as compared to children who had positive change in both variables (p < 0.001). The sensitivity, specificity and likelihood ratio of the positive test for negative change or no change in HB was 65%, 85% and 4.3, respectively. Similarly, these were 80%, 73% and 3% for negative or no change in Absolute Lymphocyte Count (ALC). These findings indicate the feasibility and effectiveness of implementing an ART program in a large government hospital in India. Simple nutritional variable hemoglobin and immunologic variable ALC could be used to monitor the progression of disease in children.

The Relationship between Glucagon-Like Peptide 2 and Feeding Intolerance in Preterm Infants

Ozer, E. A., Holst, J. J., Duman, N., Kumral, A., Ozkan, H. — 2008-05-22

Glucagon-like peptide 2 (GLP-2) is a hormone produced primarily in the distal intestine, stimulated by enteral nutrients, and playing diverse roles in the intestinal adaptation and growth. We aimed to investigate whether GLP-2 may play a role in the development of feeding intolerance which is a common problem in preterm newborns resulting from the intestinal immaturity. The study included 20 term and 28 preterm neonates. Of preterm babies, 13 showed feeding intolerance fulfilling at least one of the following criteria: abdominal distension, increased gastric residual volume and presence of bile in the gastric aspirate. The plasma GLP-2 levels measured prior to enteral feeding (fasting level) and at 60 min after the beginning of the feeding (post-pradial level) were correlated with of clinical parameters. There was no statistical difference between GLP-2 levels of overall preterm babies and those of term newborns. However, preterm neonates with feeding intolerance showed significantly lower levels of GLP-2 and increased duration to achieve full enteral feeding and hospitalization. It is suggested that GLP-2 plays a significant role in the regulation of feeding in newborns and that preterm babies with low levels of GLP-2 carry a risk for development of feeding intolerance. It may, therefore, be of relevance to investigate the therapeutic and prophylactic effects of GLP-2 administration in the preterm babies.

Factors Associated with Immunization Coverage of Children in Assam, India: Over the First Year of Life

Phukan, R. K., Barman, M. P., Mahanta, J. — 2008-05-01

The children of Assam in the North-East Region of India have consistently evidenced low rates for routine childhood immunizations. This study has been conducted to evaluate the factors affecting the immunization coverage in the first year of life of the children. About 62.2% of the children were fully immunized. Lack of information among the parents was one of the major causes of drop out of vaccinations. The children from urban areas and mother's education level showed significant role in immunization coverage. Improvement in female literacy coupled with the reduction in the drop out rate would add to achieve a higher target of immunization among children in the study area.

Children with Human Immunodeficiency Virus Infection Admitted to a Paediatric Intensive Care Unit in South Africa

Rabie, H., de Boer, A., van den Bos, S., Cotton, M. F., Kling, S., Goussard, P. — 2007-11-25

Background: Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICUs) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission. Objectives: The objective of the study is to describe the prevalence, duration of stay and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission.

Methods: Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January–31 December 2003 was studied.

Results: Of 465 patients admitted, 47 (10%) were HIV infected. For HIV-infected children, the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and 4 shortly afterwards; poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically, the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection. Conclusions: HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.