Asian Journal of Pediatric Research

Echocardiographic Findings in Children of Chronic Kidney Disease

Farhana Yasmin — 2021-12-13

Background: Patients with Chronic Kidney Disease (CKD) are at significantly increased risk for both morbidity and mortality from cardiovascular disease (CVD). Determining the spectrum of echocardiographic abnormalities in these patients can help in reduction of morbidity and mortality from CKD.

Materials and Methods: This cross-sectional study was held on department of Pediatric Nephrology, Dhaka Shishu Hospital, Dhaka, during July 2018 to December 2018 (Six months). A total of thirty-six children with chronic kidney disease with creatinine clearance <60ml/min/1.73 m2 and age ranged from 2 to 16 years on supportive treatment and hemodialysis were included. In control group equal number of age and sex matched healthy children without any preexisting renal or cardiovascular diseases were included. Both study group and control group were assessed for cardiovascular findings by echocardiography.

Results: The mean age was 9.09±3.01 years (mean±SD) in case group and 7.85±3.69 years (mean±SD) in control group. Regarding sex, 22 patients (61.1%) in the case group were male and 14 (38.9%) were female. In this study, in CKD patients significant (p<0.001) difference was observed in following cardiac parameters, left ventricular end diastolic diameter (LVEDD) (38.34 vs 34.52), left ventricular end systolic diameter LVESD (26.64 vs 20.75), interventricular septal thickness (IVS) (9.34 vs 7.27), left ventricular posterior wall thickness (LVPWT) (8.36 vs 7.46), ejection fraction (EF) (56.68% vs 70.36%), fractional shortening (FS) (31.88% vs 38.30%) and peak early diastole velocity/peak atrial filling velocity (E/A ratio) (1.15 vs 1.45) when compared to control group. Most common cardiac abnormality in children with chronic kidney disease were left ventricular systolic dysfunction (44.4%), mild pulmonary hypertension (30.6%) and left atrial dilatation (27. 8%).

Conclusion: Left ventricular systolic dysfunction was the commonest echocardiographic findings in CKD children. There was also significant difference in diastolic function between study and control group.

Neonatal Morbidity Pattern among Infants Born to Diabetic Mothers at Jamhouria Hospital, Benghazi- Libya

Munera Awad Radwan — 2021-12-14

Introduction: Diabetes has long been associated with maternal and perinatal morbidity and mortality. The infant of a diabetic mother have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risks of abortions and stillbirths. Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequallae, including abnormalities of growth, glucose and calcium metabolism, hematologic status, cardio- respiratory function, bilirubin metabolism, and congenital anomalies. The causes of the fetal and neonatal sequallae of maternal diabetes are Multifactorial. However, many of the perinatal complications can be traced to the effect of maternal glycemic control on the fetus & can be prevented by appropriate periconceptional & prenatal care.

Objective: to describe the morbidity pattern among infants of diabetic mothers (IDMs) either gestational or preconception diabetes mellitus.

Methods: A cross sectional study was conducted in Jamhouria hospital/ neonatal ward & enrolled 120 consecutive infants born to diabetics mother either gestational or preconception diabetes mellitus over one year period.

Results: 120 babies were diagnosed as IDMs and were admitted to Neonatal intensive care unit, male, female, 74(60.8%) were gestational diabetes, and 46 (38.3%) with preconception diabetes, full term comprise 98 cases (81.6%) while premature were 22 cases (18.3%). For birth weight 20 case [16.7%} were low birth weight, macrosomia represent 16 case (13.3%).

Most common congenital anomalies was cardiac lesion 36 cases, for GDM 18 case =24.3% were PCDM 18 case around 40.0%.

Central nervous system 11 case (9.1%) all of them dilated ventricular system& only 2 of them need surgical intervention with shunt.

Gastrointestinal anomalies 4 cases {3.4%} 2 of them ectopic anus & 2 short bowel syndrome.

Most common metabolic disturbance was Hypocalcemia 17 case (14.1%), followed by hypoglycemia 11 case (9.1%), followed with hyper bilirubinemia 3 cases (2.5%)

Followed by Respiratory distress syndrome 26 case (21.6%), 17 case hyaline membrane disease (14.1%) ,transient tachypnea of neo born 9 cases (7.5%) , Birth trauma 3 cases Erb,s palsy one of them birth asphyxia.

Conclusion: Most common type of diabetes in pregnancy is gestational diabetes, and most common congenital anomalies is the cardiac lesion & the most common metabolic disturbance is the hypocalcemia. Macrosomia associated with large birth weight as well as birth trauma. Large for gestational age and hypoglycemia associated mainly with poor maternal glycemic control.

A Case Series of Cyclic Vomiting Syndrome in Children at Pediatric Gastroenterology Clinic in Benghazi Medical Center

Omelkhir I. Elbanoni — 2021-12-14

Background: Cyclic vomiting syndrome (CVS) is a functional disorder characterized by repeated episodes of sudden onset of intense vomiting that is followed by symptom-free periods. The diagnosis is based on the fulfillment of Rome IV criteria. The Cyclic vomiting syndrome shares similar features to migraine headaches. It is under-recognized and often misdiagnosed with significant delays in therapy.

Aims: To evaluate the clinical characteristic of pediatric patients diagnosed with cyclic vomiting syndrome in our institution and their response to treatment.

Patients and Methods: A prospective case series of 13 pediatric patients with cyclic vomiting syndrome seen between period of November 2018 to November 2020 at pediatric gastroenterology outpatient’s clinic in Benghazi medical center. All relevant data including; age and sex, age of presentation, duration of symptoms, age at diagnosis, presence of aura or prodromal symptoms, patient or family history of headache, treatment and their response to treatment were collected.

Results: The mean age for diagnosis was 112.2 ± 37.7 months. 46.2% of patients had recognizable prodromal symptoms. Patients with CVS had intense nausea and persistent vomiting that requiring hospitalization. In 44.4% of patients had stopped the episodes as a response to propranolol.

Conclusion: Cyclic Vomiting Syndrome (CVS) is a functional, an under-recognized, and misdiagnosed episodic. The illness is characterized by stereotypical pattern of vomiting leading to frequent hospitalizations.

Assessment of Thoracic Abnormalities in Premature Infants

Celina Elias D’souza — 2021-12-18

Background: There is a large incidence of congenital thoracic abnormalities that manifest as deformities and or defects of anterior chest walls. Thoracic abnormalities in preterm infants may also be associated with malpositioning in the incubator in the presence of respiratory disease and prolonged mechanical ventilation. Immaturity of respiratory and musculoskeletal system need to compromise biomechanical function of thorax. Thus, the purpose of the study is to access the thoracic alteration and the factors associated with its abnormalities in the infants born prematurely.

Objective: Assess thoracic alteration in premature infants.

Methods: This was an observational study with infants in first year of age, born prematurely with birth weight < 2000g. Exclusion criteria were: major congenital malformations as defined by the centers for disease contol and prevention, grade III/IV intraventricular hemorrhage or preventricular leucomalacia. Physical examinations were performed independently to assess shoulder elevation and thoracic alterations.

Results: 34 infants born prematurely were included for the study according to the inclusion criteria from which 20 infants (58.8%) showed thoracic abnormalities and remaining 14 infants (41.1%) were without abnormalities.

Conclusion: The prevalence of thoracic abnormalities was high in infants born prematurely, and was associated with pulmonary disease, and may also have compromised the growth rate of these infants during the first year of life.

Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Aliou Abdoulaye Ndongo — 2021-12-20

Background and Aim: Idiopathic nephrotic syndrome or nephrosis causes massive protein leakage in the urine. Its treatment requires steroids (prednisone, methylprednisolone), often for a prolonged period, notably in case of steroid-dependence or steroid-resistance. In children, long-term use of steroids can lead to several side effects such as statural growth retardation/ stunting. This study evaluated the frequency of stunting in idiopathic nephrotic syndrome in children on steroids and identified the associated factors.

Material and Methods: This was a retrospective, descriptive cohort study carried out in children aged 0 to 16 years treated at the paediatric nephrology unit of Aristide Le Dantec Hospital in Dakar, between 1 December 2017 and 31 May 2020. All records of nephrotic children treated in outpatient or inpatient setting were included. These children had to be on corticosteroid therapy for at least 30 months and have a height taken regularly during follow-up consultations.

Results: Of 259 children followed for idiopathic nephrotic syndrome, 93 were included in the study. The median age was 96.5 months and the sex ratio was 1.9. The mean height of the children at the beginning of the follow-up was -0.26 DS, at the end it was -0.88 DS. At the beginning of the follow-up, 8 children had already stunting. At 12 months follow-up, 72 children (77.4%) had a decrease in z-score; and at 30 months, there were 7 more children (84.9%) who had a decrease in z-score. Methylprednisolone boluses were given to 17 children (18.3%). Calcium supplementation was done in 91 children (97.8%). Vitamin D supplementation was given to 91 children (97.8%). The mean number of relapses was 1.8. Factors associated with stunting were number of relapses ≤3 (p=0.03), duration of corticosteroid therapy >6 months (p<0.0001) and cumulative doses of prednisone >100 mg/kg (p=0.04).

Conclusion: In prolonged nephrotic syndrome in children, corticosteroids can cause stunting.

Maternal Experiences of Home-based Kangaroo Mother Care Following Discharge from a Rural-Urban Health Facility, Nsawam Government Hospital, Ghana

Patricia Cyriaano — 2021-12-20

Background: Preterm birth (PTB) is the leading cause of child mortality worldwide and Sub-Saharan Africa is disproportionately affected. Inadequate access to cost-effective interventions in most poor resource areas threatens to increase preterm birth related mortalities. Kangaroo mother care has proven to be a cost-effective intervention and has reduced death as a result of complications of PTB by half.

Purpose: This study therefore sought to explore and document the experiences of mothers regarding KMC following discharge from Nsawam Government Hospital.

Methods: An exploratory descriptive design was used to collect data from mothers who had preterm births and their experiences of practicing kangaroo mother care at home. Fourteen participants in the Nsawam municipality were purposively selected to participate in the study. Data was analyzed using inductive thematic analyses.

Findings: The findings of the study indicated that mothers are encouraged to practice KMC based on the benefits of KMC like provision of warmth, bonding and improvement in growth and development. The study also indicated that support systems available to mothers at home included family, churches, community and healthcare providers.

Recommendations: The study recommended that; proper follow-up care should be undertaken by clinicians on mothers practicing KMC especially in their respective home environment to ensure adherence KMC practice experiences in the home.

Covid-19 and Routine Vaccination Programme: Did it Affect Badly?

Jaigam Abbas — 2021-12-20

Background: The impact of COVID-19 on general health care delivery systems has been huge including the immunization services. Several measures were taken by most of the government all over the world to prevent the spread of infection such as lockdown, wearing masks, social distancing, etc. People have suffered a lot during the pandemic, not only due to the burden of the disease but have also faced difficulties in other domains of life. One of the important concerns is the interruption of routine immunization services. The consequences of interrupted immunization services may be life-threatening, as chances of outbreaks of vaccine-preventable diseases (VPD) in susceptible children could be high.

Aim: To find out delay in routine immunization services during covid-19 and also to determine the factors associated with delay in immunization.

Materials and Methods: This study was a cross-sectional hospital-based observational study at Career Institute Of Medical Sciences And Hospital, Lucknow, India. We collected the vaccination record after lockdown from Well-Baby Clinic and telephonically from the parents, starting from 1^st June 2020 till 31^st December 2020. We checked the records of vaccination of infants to find out delay in the vaccinations, as per the National Immunization Schedule. The records of a total of 265 infants were enrolled. Out of which, 33 did not fit the inclusion criteria and therefore were excluded from this study.

Results: Findings of our study pointed that there was significant delay in routine immunization among infants. The factors responsible for delay in different vaccination observed in this study were, Phobia of COVID-19- 20%, lockdown- 22%, interruption of routine health services-15%, social myths-8%, poor transport facility- 10%, illness of child- 8%, did not notice- 3% and multiple factors- 13%.

Conclusion: COVID -19 pandemic has affected the routine immunization services that results in delay of different vaccines at different ages which may lead to outbreak of vaccine preventable diseases, so it is need of the hour to intervene at the earliest to prevent such outbreaks among children.

Teething Myths and Practices among Nursing Mothers Attending the Paediatric Outpatient Clinic in a Tertiary Hospital in Southern Nigeria

Wonodi Woroma — 2021-12-22

Background: Misconceptions about teething are prevalent even in the 21^st century, especially in developing countries like Nigeria. These myths, which are handed down from one generation to another may lead to trivialization of severe childhood illnesses as well as practices that negatively impact child morbidity and mortality.

Aim: The present study was carried out to determine teething myths and practices among nursing mothers attending the Paediatric outpatient clinic of a tertiary hospital in Southern Nigeria.

Methods and Materials: A cross-sectional study of one hundred and forty eight nursing mothers of children aged 6-24 months who had erupted at least one tooth, who visited the children’s outpatient clinic of a tertiary health facility in Southern Nigeria. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 24.0. Descriptive statistics was used. Chi square tests of significance (Fisher’s exact test) were used with a 95% confidence interval (P< 0.05).

Results: A high percentage of mothers (95.9%) associated teething with various symptoms such as fever, gum itching and diarrhoea; majority of them got information on teething from health workers, personal experience or parents. About 41.9% of the children recruited had perceived teething symptoms. Furthermore, 51.4% of respondents said teething should be treated and health workers formed the bulk of prescribers of teething medicines, the commonest of which were teething syrups, paracetamol and teething powder while the least used was herbs. About half of the respondents believed teething medicines were effective. Most respondents would take their babies to the hospital for perceived teething symptoms like fever, diarrhoea or vomiting but were less likely to visit the hospital if catarrh, drooling of saliva or sucking of the fingers was observed. The level of education, occupation, tribe, age of mother or baby, sex or position of child did not significantly affect the use of teething medication but the presence of perceived teething symptoms especially fever and vomiting did.

Conclusion: Teething myths are common among nursing mothers attending a tertiary paediatric outpatient hospital in Southern Nigeria. The most common myths associated with teething were fever, gum itching and diarrhoea for which medications such as teething syrup, paracetamol and teething powder were prescribed. The association of these symptoms with teething could lead to trivialization of potentially severe childhood illnesses thus interfering with their prompt diagnosis and management. Continuous health education of nursing mothers and the community at large may be one of the ways of enlightenment on the innocuous and normal expectation of teething so as to avoid ascribing childhood ailments to teething.

Growth Failure in Pediatric Inflammatory Bowel Disease: A Preliminary Analysis

A. Al Sahafi — 2021-12-22

Background: Inflammatory bowel disease (IBD) is a chronic relapsing disease, characterized by chronic inflammation of the gastrointestinal tract (GIT). The incidence of IBD has been increasing over the last two decades, for example, from 1999- 2008 incidence increased from 21.3 to 26.2 per 100,000. Inflammatory bowel disease is mainly classified into two types: Crohn’s disease (CD), and ulcerative colitis (UC). Both types can be identified and distinguished through laboratory tests such as ESR, CRP, and fecal calprotectin, radiographic imaging, and direct visualization via colonoscopy. The etiology of growth failure in IBD, BMI z-score of less than -2.5, is poorly understood; however, chronic inflammation, low-calorie intake, and consequential steroid treatment are the most important factors. This study aims to determine the incidence of growth failure and associated factors in pediatric patients with IBD.

Methods: This was a retrospective cohort study of children aged 15 years and below, with the diagnosis of IBD. Data were obtained from the pediatric gastroenterology department pediatric inflammatory bowel disease database from 2007 to 2017. Our study identifies the prevalence of growth failure via a calculated BMI z-score of less than -2.5 among the pediatric inflammatory bowel disease (PIBD) population. The Chi-square test is used for categorical data and Wilcoxon rank-sum test for continuous data. A p-value <0.05 was considered statistically significant. All analyses were carried out with Stata IC/15.1 (StataCorp LP, College Station, TX, USA).

Results: A total of 36 patients were included. The mean age of children with growth failure at the time of IBD diagnosis was 8 (±4), and more than half of them (58.3%) were boys. The incidence of growth failure at the time of diagnosis was 22.2% and declined to 11.1% over 26 months. Furthermore, the mean BMI z-score gradually improved from -0.741 to -0.1 over the same period of follow-up after proper management and multidisciplinary involvement.

Conclusion: Growth failure in IBD patients according to our data is uncommon, however, it was reduced by 50% over 26 months. This could be attributed to nutritional status improvement over the management period. We recommend following the stepwise approach according to the severity of the disease and managing IBD patients by a multidisciplinary team. However, due to the relatively small sample size and low growth failure incidence, a large-scale study is recommended to determine any causal relations.

Recovery Degree in Pediatric Patients with Antecedent Severe Traumatic Brain Injury in Mexico

Sujey Araceli Zurita Rivera — 2021-12-22

Aims: To determine the recovery degree in pediatric patients with antecedent severe traumatic brain injury.

Study Design: Prospective, analytical and relational.

Place and Duration of Study: Pediatrics Intensive Care Area of the “Hospital para el Niño Poblano” from March 2014 to February 2015.

Methodology: Patients aged 2 to 192 months, both sexes, with antecedent severe traumatic brain injury. The degree of recovery was determined with the Glasgow Outcome Score (GOS) at hospital discharge and one year after. Descriptive and inferential statistics were used data analysis.

Results: The study consisted of 23 patients, of which 69.56% were men. The mean age was 73.17±50.33 months. The predominant age group was middle childhood (34.78%). The main mechanism of injury was run over by a vehicle (39.13%). The group of toddler remained hospitalized for 17.50±8.58 days. Moreover, GOS at hospital discharge (p=0.391) and at one year (p=0.789) was not associated with sex. Additionally, an association of GOS at hospital discharge was found with GOS at one year of care (p=0.003), with greater improvement being observed, in those cases with less initial damage brain.

Conclusion: The degree of recovery at one year after hospital discharge in pediatric patients with antecedent severe traumatic brain injury is associated with the degree of recovery at hospital discharge. Middle childhood, being the group at greatest risk. The complications can reduce the recovery of the patient. Rehabilitation therapy provided by the public health services and the family is of vital importance.

Caregivers' Knowledge, Attitude and Practice Regarding Diarrhoea in Children under Five Years Old in Sub-Saharan Africa: An Integrative Narrative Review

Margaret Wekem Kukeba — 2021-12-10

Background: Diarrhoeal diseases constitute a significant burden on the health and growth of children the world over. Globally, diarrhoeal conditions remain the second leading cause of death among children under 5. Knowledge, attitudes and practice of caregivers are at the heart of diarrhoeal disease prevention and proper management.

Objective: This review aimed to assess caregivers' knowledge, attitude, and practice regarding diarrhoea in children under five years old in sub-Saharan Africa, as discussed in the literature.

Design: Integrative narrative review

Data Sources: The review saw an extensive search on two electronic databases. Search results were screened using inclusion and exclusion criteria. At the end of the screening, 37 studies were included in the review.

Review Methods: Inclusion criteria: Only studies whose focus was on caregivers’ knowledge, attitude and practice relating to diarrhoea in children under five were included. Also, only publications reported in the English Language were considered, and publications must have been between 2010-2020. Additionally, the methodological quality of studies was assessed using the Down & Black (1998) checklist for quality evaluation in a systematic review.

Results: In this review, it emerged that studies in Sub-Saharan Africa indicate that caregivers display poor overall knowledge about diarrhoea. Also, the attitudes of caregivers towards diarrhoea prevention and treatment was low in many studies. On care practices, prevention practices, and management/treatment practices, including ORS and Zinc usage, were mainly reported to be quiet.

Conclusions: The review concluded that there are poor levels of knowledge, attitude and practice of managing diarrhoea among caregivers of children under five (5) years of age in sub-Saharan Africa. The researchers recommended continuous health education to address knowledge gaps of mothers about diarrhoea, its prevention and treatment according to international standards.