Open Access Case Study

Digestive Disease in Chronic Inflammatory Diseases in Children (About 10 Cases)

M. Kabbaj, B. Chkirate, A. Bentahila

Asian Journal of Pediatric Research, Page 39-45
DOI: 10.9734/ajpr/2022/v10i1189

Introduction: Digestive involvement is not uncommon during chronic inflammatory diseases in children, it may be just digestive manifestations other than other systemic signs or association of two different pathologies with a common immunological terrain.

Objective: To recognize the different types of digestive involvement encountered during chronic inflammatory diseases in children and to discuss the frequency of association of digestive involvement with chronic inflammatory diseases in children .

Materials and Methods:  Retrospective study involving 10 children with chronic inflammatory diseases with digestive involvement collected at the department of pediatrics IV and the consultation of pediatric rheumatology of the children's hospital of Rabat over a period of 17 years (2001-2018).

Results: Our series includes 7 female and 3 male children.

The average age of our patients at the time of diagnosis of JIA or SLE is 10 years and the average age of the digestive involvement is 07 years.

The types of digestive involvement found were diverse: Crohn's disease, ulcerative colitis and celiac disease.

The frequency of digestive involvement in chronic inflammatory diseases in our series is 1.58%. The incidence of association of juvenile idiopathic arthritis with IBD is 1.08% and with                         celiac disease is 0.4%, while the frequency of association of systemic lupus with celiac disease is 2.8%.

Conclusion:  There is a very strong link between digestive involvement and chronic inflammatory diseases, The common etiopathogenic mechanisms that explain this link are not yet well defined, but genetic predisposition seems to play an important role in these associations, as well as environmental factors such as long exposure to gluten, for celiac disease.

Open Access Original Research Article

Estimation of Glomerular Filtration Rate Using Serum Cystatin C as an Early Predictor of Renal Insufficiency in Overweight/ Obese Children and Adolescents with Non-alcoholic Fatty Liver Disease

Randa Abdel Sattar El Hewala, Saleh Mohamed Amin Saleh, Safwat Mohamed Kasem, Maher AhmedAbdel Hafez

Asian Journal of Pediatric Research, Page 1-11
DOI: 10.9734/ajpr/2022/v10i1182

Background: NAFLD is a clinical spectrum ranging from steatosis (fatty infiltration) to steatosis with inflammation, necrosis, fibrosis and cirrhosis resembling alcoholic hepatitis in the absence of alcoholic abuse. The aim of this work was to determine early renal functional alterations in overweight / obese children and adolescents with NAFLD, as assessed by estimated glomerular filtration rate using cystatin C, and to evaluate its relation to the degree and various clinic-laboratory parameters of NAFLD.

Methods: This case control research included 60 overweight and obese children and adolescent. The Cases were classified into two equal groups: group 1: overweight or obese children and adolescents with NAFLD and group 2: overweight or obese children and adolescents without NAFLD. Twenty healthy age-and-sex matched children with BMI less than the 85th percentile for age and sex were chosen as controls.

Results: There was significantly positive correlation among serum cystatin C and weight, BMI, Waist/Hip ratio, ALT, AST, cholesterol, Hip circumference, Fasting plasma insulin and Insulin resistance. There was significantly negative correlation among serum cystatin C and eGFR. There were significant negative correlations between eGFR and weight z score, BMI z score, hip circumference, waist/hip ratio, ALT, AST, cholesterol, fasting plasma insulin, insulin resistance and cystatin C.

Conclusions: Serum Cystatin C correlated significantly to the degree of hepatic steatosis. Values of eGFR were significantly lower in NAFLD patients compared to those without NAFLD and controls. The reduction in eGFR was correlated significantly with the degree of hepatic steatosis. There was a statistically significant negative correlation between serum cystatin C and eGFR. Levels of eGFR were significantly correlated with weight, BMI, W/H ratio, ALT, AST, cholesterol and insulin resistance.

Open Access Original Research Article

Impact of National Clinical Practice Guidelines on Exchange Transfusion for Severe Neonatal Hyperbilirubinemia in Singapore

W. D. Ng, C. J. Jeyanthi, V. S. Rajadurai

Asian Journal of Pediatric Research, Page 12-18
DOI: 10.9734/ajpr/2022/v10i1184

Aims: To review the incidence of double volume exchange transfusion for severe neonatal hyperbilirubinemia in infants ≥35 weeks’ gestational age before and after implementation of National Clinical Practice Guidelines (NCPGNJ), analyze etiologies for severe hyperbilirubinemia, readmission rates for phototherapy and neurodevelopmental outcomes up to 2 years.

Study Design:  Retrospective study

Place and Duration of Study: KK Women’s and Children’s Hospital, Singapore, between January 2016 and December 2021.

Methodology: National Clinical Practice Guidelines on Evaluation and Management of Neonatal Jaundice (NCPGNJ) was implemented in January 2019. We retrospectively reviewed the medical records of neonates in our center who underwent double volume exchange transfusion for severe neonatal hyperbilirubinemia before and after implementation of the national clinical practice guidelines.

Results: Overall, 56 infants underwent double volume exchange transfusion for severe hyperbilirubinemia during the study period. There was a decline in the incidence of exchange transfusion from 107 per 100 000 live births in epoch 1 (2016-2018) to 61 per 100 000 live births in epoch 2 (2019-2021). There was a steady decline in overall phototherapy rates (p=0.06), readmission rates for phototherapy (p=0.04) and number of neonates needing exchange transfusion (p=0.25). ABO-hemolytic disease of the newborn was the most common etiology. One infant had delayed presentation of severe hyperbilirubinemia and eventually developed cerebral palsy. The rest of the infants had normal neurodevelopmental and audiological assessments at follow-up.

Conclusion: The evidence-based National Clinical Practice Guidelines (NCPGNJ) has reduced the incidence of exchange transfusion. It provides a unified framework for all healthcare professionals who manage neonates with hyperbilirubinemia in different healthcare settings.

Open Access Original Research Article

Sociodemographic and Clinical Risk Factors Associated with Mortality in Children with Acute Meningitis Admitted at Lubango Pediatric Hospital – Angola

Ketha Francisco, Gilberta Benguela, Joana Chitungu, Olukunmi Omobolanle Balogun, Lino Tchicondingosse

Asian Journal of Pediatric Research, Page 19-29
DOI: 10.9734/ajpr/2022/v10i1185

To reach the ambitious target of the UN Sustainable Development Goal (SDG), with countries aiming to end preventable death of newborn and under five children and reduce the mortality rate among children under 5 years to at least 25 per 1000 live birth, we need to understand the principles preventable causes and risk factors leading to child mortality. Among these preventable diseases, meningitis has one of the highest fatality rates and the potential to cause long term disability and devastating epidemics. This study is the first one in trying to identify the risk factors associated in mortality with meningitis in children admitted at luabango pediatric hospital.

We conducted a retrospective cross-sectional study to identify the sociodemographic and clinical risk factors associated with mortality in children admitted with the diagnosis of meningitis at lubango pediatric hospital, Angola. Following approval of the ethics committee at Lubango Pediatric Hospital, records of patients diagnosed with acute meningitis between 2020 and 2021 was extracted from infectious ward file record. Data was analyzed using SPSS 23.

20 (26.7%) of children admitted at lubango Pediatric hospital with the diagnosis of meningitis during the period of the study died.

Mother’s level of education ((P: 0.000), Vaccination status of the children (P:0.018) and vomiting (P: 0.007) were associated with mortality in a Bivariate analysis.

Lethality rate of children with the diagnosis of meningitis admitted at lubango Pediatric hospital during the period of the study was 26.7%.

mother’s level of education, Vaccination status of the children and vomiting were strongly associated with mortality.

Open Access Original Research Article

Adequate Position and Recommended Time for Initial Steps of Neonatal Resuscitation

Luis Ángel Bolio-Molina, Gabriela Toledo-Verónico, Víctor Manuel Bolio-Molina, Josefa Dominga Bolio-Molina

Asian Journal of Pediatric Research, Page 30-38
DOI: 10.9734/ajpr/2022/v10i1187

Background: The Neonatal Resuscitation Program highlights the importance of a newborn's first minute, the "Golden Minute", during which the pediatrician determines if a newborn requires, and initiates advanced resuscitation. From birth to the first neonatal evaluation, we detect periods that we call "Lost Time", that delay advanced resuscitation because it is not controlled: The "adequate position" in which gynecologists must "pass" and pediatricians "receive" the newborn; The transfer time to the radiant warmer and; The duration of the initial steps.

Objectives of the Study: 1. Present and propose what we consider the "adequate position" to "pass" and "receive" the newborn at each birth. 2. Expose “LT” detected, and how to eliminate them; 3. Establish the adequate time for each initial step of neonatal resuscitation.

Methodology: Observational, descriptive, comparative, triple-blind study. We recorded the position in which gynecologists pass to the newborn, and pediatricians receive, the transfer time to the radiant warmer, and the duration of the initial steps, in 150 deliveries and 150 cesarean sections. Results were analyzed with descriptive statistics, X2, T-test.

Results: The position to pass and receive the newborn was incorrect and delayed. The transfer time to the radiant warmer was long. The duration of the initial steps was longer than expected. Without differences between both groups.

Conclusions: Planning and accelerating the "adequate position" to "pass and receive" the neonate at each birth, reducing the transfer time to the radiant warmer and shortening the duration of the initial steps, allow us to eliminate lost time, optimize the golden minute of resuscitation and improve neonatal outcomes.