The role of chest X-ray in the diagnosis of neonatal respiratory distress syndrome: a systematic review concerning low-resource birth scenarios.

BACKGROUND: Access to diagnostic tools like chest radiography (CXR) is challenging in resource-limited areas. Despite reduced reliance on CXR due to the need for quick clinical decisions, its usage remains prevalent in the approach to neonatal respiratory distress syndrome (NRDS). OBJECTIVES: To assess CXR's role in diagnosing and grading NRDS severity compared to current clinical features and laboratory standards. METHODS: A review of studies with NRDS diagnostic criteria was conducted across six databases (MEDLINE, EMBASE, BVS, Scopus-Elsevier, Web of Science, Cochrane) up to 3 March 2023. Independent reviewers selected studies, with discrepancies resolved by a senior reviewer. Data were organised into descriptive tables to highlight the use of CXR and clinical indicators of NRDS. RESULTS: Out of 1,686 studies screened, 23 were selected, involving a total of 2,245 newborns. All selected studies used CXR to diagnose NRDS, and 21 (91%) applied it to assess disease severity. While seven reports (30%) indicated that CXR is irreplaceable by other diagnostic tools for NRDS diagnosis, 10 studies (43%) found that alternative methods surpassed CXR in several respects, such as severity assessment, monitoring progress, predicting the need for surfactant therapy, foreseeing Continuous Positive Airway Pressure failure, anticipating intubation requirements, and aiding in differential diagnosis. CONCLUSION: CXR remains an important diagnostic tool for NRDS. Despite its continued use in scientific reports, the findings suggest that the study's outcomes may not fully reflect the current global clinical practices, especially in low-resource settings where the early NRDS approach remains a challenge for neonatal survival.Trial registration: PROSPERO number CRD42022336480.

Main findings: Access to diagnostic tools like chest radiography is challenging in resource-limited areas, yet its usage persists in the management of neonatal respiratory distress syndrome despite a decreased dependency due to the imperative for swift clinical decisions.Added knowledge: Despite its continued significance in scientific literature, the usage of chest radiography as a diagnostic tool for neonatal respiratory distress syndrome may not entirely reflect current global clinical practices, particularly in low-resource settings where early management of neonatal respiratory distress syndrome poses a challenge for neonatal survival.Global health impact for policy and action: The results underscore the necessity of guidelines for the utilisation of chest radiography to minimise unnecessary ionising radiation exposure while ensuring timely access to critical clinical information for appropriate newborn care.

Safe administration of yellow fever vaccine in patients with suspected egg allergy.

Background: The evidence available in the literature on the administration and safety of the yellow fever vaccine in patients with egg allergy is limited. Objective: We sought to describe the administration of yellow fever vaccine in children with suspected egg allergy using a simplified protocol. Methods: Children referred to the service from February 2018 to January 2020 with a history of possible egg allergy were classified as probably egg-allergic or not on the basis of history and specific IgE testing. A vaccine prick test was performed only in those with a history of an anaphylactic reaction to egg ingestion and if the result was positive the vaccine was administered in a 2-step protocol (2 equal doses of 0.25 mL with an interval of 30 minutes between the 2 applications). All other children received the vaccine as a single dose. Results: A total of 435 children were evaluated; 48.27% were probably not allergic, and 51.72% were probably allergic to egg, of which 32.88% were considered anaphylactic. A total of 414 (95.2%) children had no vaccine reactions. Of the 21 (4.8%) children who had some reaction, 10 experienced a local reaction, 9 a mild skin reaction distant from the vaccine site, 1 presented local cutaneous reaction distant to the vaccination site, and 1 patient developed possible anaphylaxis. The vaccine prick test did not predict a vaccine reaction (odds ratio, 1.29; 95% CI, 0.25-6.72; P = .67). Conclusions: Yellow fever vaccine can be safely administered as a single dose in children with a confirmed or suspected egg allergy.

Neurological manifestations due to dengue virus infection in children: clinical follow-up.

The aim was to assess neurological complications in children with an invasive neurological disease by dengue virus (DENV) and the time to resolve symptoms after hospital discharge. A prospective study was conducted at a referral hospital for infectious diseases in Brazil between March 2014 and July 2019. All children hospitalized with neurologic manifestations and DENV RNA detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) in cerebrospinal fluid (CSF) were followed up until complete resolution of neurological complications. On average, they were followed up for 16 months. Among 56 DENV-positive children, 39% had some neurologic complications after hospital discharge and found that 19.6% were discharged with anticonvulsants due to seizures, 10.7% developed motor complications (e.g. muscle weakness, paresis, ataxia, and walking disability), 5.4% had headaches, and 14.3% had sleep disorders. Among the 56 children, only three had a clinical diagnosis of dengue because the symptoms are nonspecific and 35% showed no change in cerebrospinal fluid (CSF). The average time to resolve complications was 5.9 months (ranging from 1 m to 32 m). These results should alert physicians to the difficulties of a clinical diagnosis of an infection that causes neurological complications after discharge in a significant number of children. RT-qPCR's etiological diagnosis of DENV infection enabled better clinical follow-up for early intervention in children with neurological complications.

Prematurity detection evaluating interaction between the skin of the newborn and light: protocol for the preemie-test multicentre clinical trial in Brazilian hospitals to validate a new medical device.

INTRODUCTION: Recognising prematurity is critical in order to attend to immediate needs in childbirth settings, guiding the extent of medical care provided for newborns. A new medical device has been developed to carry out the preemie-test, an innovative approach to estimate gestational age (GA), based on the photobiological properties of the newborn's skin. First, this study will validate the preemie-test for GA estimation at birth and its accuracy to detect prematurity. Second, the study intends to associate the infant's skin reflectance with lung maturity, as well as evaluate safety, precision and usability of a new medical device to offer a suitable product for health professionals during childbirth and in neonatal care settings. METHODS AND ANALYSIS: Research protocol for diagnosis, single-group, single-blinding and single-arm multicenter clinical trial with a reference standard. Alive newborns, with 24 weeks or more of pregnancy age, will be enrolled during the first 24 hours of life. Sample size is 787 subjects. The primary outcome is the difference between the GA calculated by the photobiological neonatal skin assessment methodology and the GA calculated by the comparator antenatal ultrasound or reliable last menstrual period (LMP). Immediate complications caused by pulmonary immaturity during the first 72 hours of life will be associated with skin reflectance in a nested case-control study. ETHICS AND DISSEMINATION: Each local independent ethics review board approved the trial protocol. The authors intend to share the minimal anonymised dataset necessary to replicate study findings. TRIAL REGISTRATION NUMBER: RBR-3f5bm5.

Infection surveillance in pediatric hematopoietic stem cell transplantation recipients.

OBJECTIVE: To describe the profile of reported healthcare-associated infections (HAIs) in pediatric patients submitted to hematopoietic stem cell transplantation (HSCT) at a reference center. METHODS: Retrospective cohort of pediatric patients who were submitted to HSCT from 2008 to 2016. The criteria for HAI were based on those established by the National Healthcare Safety Network. Data were collected by active surveillance performed daily by professionals. This study was approved by the institutional research ethics committee. RESULTS: A total of 86 HSCTs were performed in 81 patients younger than 18 years of age (median, 10 years). Of these, 69 (85%) were males. Aplastic anemia and leukemia were the main diagnoses. A total of 140 HAIs were diagnosed with an incidence density of 28.2 infections/1000 patient-days. The most common HAI was laboratory-confirmed bloodstream infection (46), the majority of which was reported to be central venous catheter-associated (43). Gram-negative bacteria were the most prevalent microorganisms (58.5%). Almost all the infections occurred until 30 days after transplantation, and 17 deaths were observed within 180 days after the procedure. CONCLUSION: Active surveillance of HAIs in HSCT children allowed the evaluation of the incidence and profile of HAIs, which is essential for the health care of these patients.