Clinical characteristics and prognostic marker for hospitalization in children with influenza infection in an emergency setting.

BACKGROUND: Influenza is a main cause of illnesses during seasonal outbreaks. Identifying children with influenza who may need hospitalization may lead to better influenza outcomes. OBJECTIVE: To identify factors associated with the severity of influenza infection, specifically among children who were admitted to the hospital after being diagnosed with influenza at the emergency department. METHODS: A retrospective cohort study was conducted among pediatric patients (age < 18 years) with a positive influenza rapid test who visited the emergency department at Srinagarind hospital between January2015-December2019. The dependent variable was hospital admission, while the independent variables included clinical parameters, laboratory results, and emergency severity index(ESI). The association between these variables and hospital admission was analyzed. RESULTS: There were 542 cases of influenza included in the study. The mean age was 7.50 ± 4.52 years. Males accounted for 52.4% of the cases. A total of 190(35.05%) patients, needed hospitalization. Patients with pneumonia, those who required hospitalization or were admitted to the critical care unit, consistently exhibited an elevated absolute monocyte count and a reduced lymphocyte-to-monocyte ratio (LMR). Various factors contribute to an increased risk for hospitalization, including ESI level 1-2, co-morbidity in patients, age < 1 year old, and an LMR below 2. CONCLUSIONS: ESI level 1-2 and co-morbidity in patients represent significant risk factors that contribute to higher hospitalization admissions. A LMR below 2 can be used as a prognostic marker for hospitalization in children with influenza infection.

Safety and Immunogenicity of a New Inactivated Polio Vaccine Made From Sabin Strains: A Randomized, Double-Blind, Active-Controlled, Phase 2/3 Seamless Study.

BACKGROUND: A new inactivated polio vaccine made from Sabin strains (sIPV) was developed as part of the global polio eradication initiative. METHODS: This randomized, double-blind, active-controlled, phase 2/3 seamless study was conducted in 2 stages. Healthy infants aged 6 weeks were randomly assigned to receive 3 doses of 1 of 4 study vaccines at 6, 10, and 14 weeks of age (336 received low-, middle-, or high-dose sIPV, or conventional IPV [cIPV] in stage I, and 1086 received lot A, B, or C of the selected sIPV dose, or cIPV in stage II). The primary outcome was the seroconversion rate 4 weeks after the third vaccination. RESULTS: In stage I, low-dose sIPV was selected as the optimal dose. In stage II, consistency among the 3 manufacturing lots of sIPV was demonstrated. The seroconversion rates for Sabin and wild strains of the 3 serotypes after the 3-dose primary series were 95.8% to 99.2% in the lot-combined sIPV group and 94.8% to 100% in the cIPV group, proving the noninferiority of sIPV compared to cIPV. No notable safety risks associated with sIPV were observed. CONCLUSIONS: Low-dose sIPV administered as a 3-dose vaccination was safe and immunogenic compared to cIPV. CLINICAL TRIALS REGISTRATION: NCT03169725.

Etiological and predictive factors of pediatric urticaria in an emergency context.

BACKGROUND: Urticaria is common in pediatric population and is caused by various etiologies which usually differ among different age groups. The different etiologies require different management strategies. Thus, understanding detailed of the etiologies of urticaria in children would help pediatricians to perform appropriate initial treatment. METHODS: A cross-sectional epidemiological study of all patients aged under 18-year-old with the diagnosis of urticaria from any causes entered in the emergency department during January 1st, 2016 to December 31st, 2019 by collecting the data from the Health Object Program®, an authorized electronic medical records program, at the Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. RESULTS: There were total of 515 urticaria patients aged under 18 years old at the emergency department. The ages of patients ranged from 8 months to 18 years with a median age of 7 years (IQR 3.17-12.08). The majority of the patients were in the preschool-aged group (40.97%), followed by the school-aged (28.16%), adolescent (22.14%), and infant (8.74%). Six major etiologic categories were identified in the present study. The most common cause of urticaria was infection (51.26%), followed by idiopathic urticaria (34.37%), inhalants (6.99%), drugs (4.08%), foods (2.52%), and insect stings (0.78%). CONCLUSIONS: Having underlying allergic diseases had a strong association with all identified causes of urticaria in the study population, of which, food and inhalation etiologies had a significant difference when compared to the other identified causes. The present study has found that infection was the most common cause of acute urticaria in children. This etiology (infection-induced urticaria) usually presents concurrent with fever, however, non-febrile symptoms were also presented. Therefore, in the pediatric population, pediatricians should always look for infection as the cause of urticaria even in patients without pyrexia.

Assessment of small airway function and reversibility in symptom-controlled asthma in pediatric patients.

BACKGROUND: The goals of asthma management aim to control the symptoms and minimize future risk. There is, however, an option to stop controller medication if the patient has been well-controlled for at least 6-12 months. To assess control, both clinical symptom assessment and lung function should be monitored periodically. In practical clinical practice of pediatric patients, lung function is not available at all health centers. OBJECTIVES: to determine lung function with a focus on small airway function and the risk of reversibility among children who have been symptom-controlled. METHODS: Our participants were symptom-controlled asthmatic children according to GINA Guideline for at least 6 months with low dose inhaled corticosteroid. Written informed-consent was given by the parents and the children. They performed a self-evaluated symptom-controlled test (C-ACT) and a spirometric assessment. Abnormal lung function was defined as FEV1±80%, FEV1/FVC < 80%, and FEF25-75 <65% predicted. Airway reversibility was determined by the change of FEV1 >12% and FEF25-75 >30% post bronchodilator. RESULTS: Forty children (65% male) were enrolled. Age ranged between 6.7 and 15.0 years. The mean C-ACT score was 25.2 ± 1.7. Spirometry results were: mean FEV1 84.0 %, FEV1/FVC 87.8%, and FEF25-75 85.5% predicted. Normal FEV1 was found among 72.5% of participants compared to normal FEF25-75 in 87.5%. Among the abnormal FEV1 and FEF25-75, all were of mild severity as 10% retained airway reversibility. CONCLUSION: Children with well-controlled asthma, based on their symptom assessment, may have persistent abnormal lung function. Spirometry should be performed before considering cessation of controller medication.

The Utilization of the Surviving Sepsis Campaign Care Bundles in the Treatment of Pediatric Patients with Severe Sepsis or Septic Shock in a Resource-Limited Environment: A Prospective Multicenter Trial.

BACKGROUND: Sepsis is a common condition affecting the lives of infants and children worldwide. Although implementation of the surviving sepsis campaign (SSC) care bundles was once believed to be effective in reducing sepsis mortality rates, the approach has recently been questioned. METHODS: The study was a prospective, interventional, multicenter trial. Infants and children aged 1 month to 15 years in seven different large academic centers in Thailand who had been diagnosed with severe sepsis or septic shock. They were given treatment based on the SSC care bundles. RESULTS: A total of 519 children with severe sepsis or septic shock were enrolled in the study. Among these, 188 were assigned to the intervention group and 331 were recruited to the historical case-control group. There were no significant differences in the baseline clinical characteristics. The intervention group was administered a significantly higher fluid bolus than was the control group (28.3 ± 17.2 cc/kg vs. 17.7 ± 10.6 cc/kg; P = 0.02) with early vasopressor used (1.5 ± 0.7 h) compared to control group (7.4 ± 2.4 h, P < 0.05). More importantly, our sepsis mortality reduced significantly from 37% ± 20.7% during the preintervention period to 19.4% ± 14.3% during the postintervention period (P < 0.001). CONCLUSION: Our study demonstrated a significant reduction in sepsis mortality after the implementation of the SSC care bundles. Early diagnosis of the disease, optimum hemodynamic resuscitation, and timely antibiotic administration are the key elements of sepsis management.

Propranolol was effective in treating cutaneous infantile haemangiomas in Thai children.

AIM: The aim of this study was to explore the efficacy and safety of propranolol in treating infantile haemangiomas, the most common benign vascular tumours in children. METHODS: We carried out a retrospective chart review of infantile haemangioma patients admitted to the Faculty of Medicine, Khon Kaen University, Thailand, from January 2009 to January 2015. RESULTS: There were 53 infantile haemangioma cases treated with oral propranolol. Treatment responses occurred as early as two weeks after propranolol administration in 91.5% of the follow-up patients, with all 53 cases achieving the desired treatment responses two months after propranolol was initiated. No significant differences in treatment responses were found between propranolol as a mono-therapy or as a combination therapy with prednisolone at the two-week (p value 0.13) and one-month follow-ups (p value 0.98). Complications were documented in three cases (5.6%) when the propranolol dose was increased, and these were asymptomatic hypoglycaemia in two cases and one case of hypotension. CONCLUSION: Propranolol was effective in treating infantile haemangiomas, and combining it with prednisolone achieved no significant differences in treatment outcome. Cases should be monitored for hypoglycaemia and hypotension. More data on using propranolol for infantile haemangiomas are needed, including long-term follow-up studies.

Vascular Anomalies: The Epidemiological Profile at Srinagarind Hospital.

BACKGROUND: Vascular anomalies or vascular birthmarks can be divided in to 2 major groups: (i) vascular tumors and (ii) vascular malformations. Currently, there are many treatment modalities for these diseases and the treatment plans are varied among sub-specialty physicians. OBJECTIVE: To explore the epidemiology of vascular anomalies at Srinagrind Hospital during 2009-2011. MATERIAL AND METHOD: Retrospective chart was reviewed from the out patient clinic's database at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. RESULTS: There were total of 126 vascular anomalies cases. 89 cases were diagnosed with vascular tumors and 37 cases were vascular malformations. Among 89 cases of vascular tumors, infantile hemangiomas are the most common type (95.5%). The treatment methods for vascular tumors were medical treatments, which were used in majority of the cases (60%), followed by surgical excision, laser treatment, intralesional corticosteroids injection, and the combination of medical, laser and surgical treatment. There were total of 37 cases of vascular malformations. Most of the cases were venous and lymphatic malformations. Treatment methods for these patients were surgical excision, bleomycin injection, and radiation. CONCLUSION: Vascular anomalies have various presentations. Treatment is challenging and multidisciplinary teams are involved in taking care the patients with this entity of disease. Setting up vascular anomalies clinic is essential and suggested for the patients with vascular anomalies' problems.

Carbamazepine-Induced Incomplete Stevens-Johnson Syndrome: Report of a Case in Children without Mycoplasma pneumoniae Infection.

Incomplete Stevens-Johnson syndrome (SJS) is a rare reactive skin condition. Most cases are occurred in children and all are associated with Mycoplasma pneumoniae (M. pneumoniae) infection. We reported an unusual case of a 6-year-old boy who developed the presentation of isolated mucosal erosion with a lack of skin findings, which indicated incomplete SJS after two weeks of carbamazepine (CBZ) administration. Findings of positive HLA-B*1502 allele supported a possible causative influence of carbamazepine inducing SJS. Interestingly, this patient was tested negatively for M. pneumoniae. This is a significant finding since there is no previous report of incomplete SJS without M. pneumoniae infection. Discontinuation of CBZ and administration of systemic corticosteroids were accomplished to treat SJS, which resulted in complete recovery. Our interesting findings highlighted the manifestation of incomplete SJS, which can present with other causes rather than M. pneumoniae infection. Early manifestation of mucosal change without typical skin lesions should not be neglected in the diagnosis of incomplete SJS.

COMPARISONS OF THE CLINICAL FEATURES AND OUTCOMES OF CHILDREN PRESENTING WITH INFLUENZA-LIKE ILLNESSES, INCLUDING A (H1N1) PDM09 AND SEASONAL INFLUENZA, IN A UNIVERSITY HOSPITAL, THAILAND.

In Thailand, during the A(H1N1)pdm2009 pandemic, 82% of fatal cases did not received the specific treatment within 48 hours of the onset of symptoms. Specific diagnostic tests, especially RT-PCR, were not available throughout the country. To assist early clinical diagnosis and treatment, this study compared the clinical features and treatment outcomes of children presenting with influenza-like illness (ILIs). These included confirmed cases of A(H1N1)pdm2009, as well as seasonal influenza and cases for which no cause could be specified. The medical records of patients aged less than 15 years with ILIs, who had RT-PCR performed for influenza virus between May 2009 and December 2011 at Srinagarind Hospital, were reviewed. Clinical features, chest radiographs and treatment outcomes were compared between those positive for A(H1N1)pdm2009, and those with seasonal influenza and/or the unspecified causes group. In 179 complete medical records, 27.4% were positive for A(H1N1)pdm2009, 13.4% for seasonal influenza and the cause of illness in the remainder was unspecified. Both A(H1N1)pdm2009 and seasonal influenza viruses infected older children more than did the unspecified group (group median ages 96,48 and 24 months, respectively). Sore throat, headache and myalgia were significantly more frequent in the A(H1N1)pdm2009 group than in the other two groups (p < 0.001). Half of all children had pneumonia but there were no significant differences among groups. There was no mortality in this study. In conclusion, sore throat, headache and myalgia were the significant clinical features suggestive of A(H1N1)pdm2009 infection in children and might be helpful indicators prompting early administration of specific treatments in the settings where definitive laboratory tests are not available.

Rhinovirus infection in children hospitalized with acute bronchiolitis and its impact on subsequent wheezing or asthma: a comparison of etiologies.

BACKGROUD: Children who suffer a viral lower respiratory infection early in life are prone to subsequent wheezing and asthma: RSV and rhinovirus are thought to be the primary causative pathogens. Epidemiologic and long-term data on these pathogens in Thailand are limited. OBJECTIVES: To detect the causative pathogens in children hospitalized with a first episode of acute wheezing and to compare the respective impact on the recurrence of wheezing and development of asthma. METHOD: We conducted a 5-year cohort study of children under 2 hospitalized with acute bronchiolitis at two tertiary hospitals. Nasopharyngeal secretions were collected at admission to determine the causative pathogens by RT-PCR. RESULTS: 145/170 samples (85%) were positive for pathogens. RSV, rhinovirus, influenza, bacteria and hMPV was found in 64.7%, 18.2%, 17.6%, 12.9% and 3.5% of children respectively. The majority (94/152; 62%) of participants reported having recurrent wheezing within the first year of follow-up (mean duration 5.5 ± 7.2 months). Only 16% still had wheezing episodes after 5 years. Asthma was diagnosed in 41 children (45%), most of whom were treated with inhaled corticosteroid. There were no statistically significant differences among the various etiologies. CONCLUSION: Rhinovirus ranked second after RSV as the cause of hospitalizations of children with acute bronchiolitis. More than half of these children had recurrent wheezing which mostly disappeared before the age of 6. Nearly half were subsequently diagnosed with asthma at the 5th year of follow-up. The specific pathogens did not account for a statistically significant difference in subsequent wheezing or asthma development.

Clinical outcomes after utilizing surviving sepsis campaign in children with septic shock and prognostic value of initial plasma NT-proBNP.

BACKGROUND AND OBJECTIVE: The surviving sepsis campaign treatment guideline (SSC) implementation is associated with improved outcome in adults with severe sepsis. The effect on outcome of pediatric sepsis is less clear. PURPOSE: To determine the clinical outcomes of SSC implementation and to investigate the prognostic value of initial plasma NT-proBNP and procalcitonin in children. MATERIALS AND METHODS: Infants and children (aged 1month/0-15 years with severe sepsis or septic shock) were prospectively enrolled and treated according to the guidelines. Initial blood drawn was saved for NT-pro-BNP, procalcitonin measurements and clinical data were also recorded. RESULTS: A total of 47 subjects were recruited. Since the application of the SSC, our mortality rate had significantly decreased from 42-19% (P = 0.003) as compared to the data in the previous 3 years. Clinical factors that significantly increased the mortality rate were: Initial central venous oxygen saturation < 7 0% after fluid resuscitation [odds ratio (OR) = 23.3; 95% confidence interval (CI) 3.7-143; P = 0.001], and initial albumin level (≤ 3 g/dl, OR = 6.7; 95% CI 1.2-37.5, P = 0.03). There was asignificant difference between the initial NT-proBNP levels between survivors and non survivors, (6280.3 ± 9597 ng/L, P < 0.001), but not for procalcitonin (12.7 ± 24.8, 29.3 ± 46 µg/L, P = 0.1), respectively. An initial NT-proBNP level of more than 11,200 pg/ml predicted Pediatric Intensive Care Unit (PICU) mortality with a sensitivity of 85.7% and a specificity of 90%. CONCLUSIONS: A modified SSC for severe sepsis and septic shock significantly reduced the mortality rate in our PICU. High initial NT-ProBNP level was associated with mortality.

Clinical Characteristics and Outcomes of Pediatric COVID-19 Pneumonia Treated with Favipiravir in a Tertiary Care Center.

The COVID-19 pandemic, caused by SARS-CoV-2, has posed significant health challenges worldwide. While children generally experience less severe illness compared to adults, pneumonia remains a substantial risk, particularly for those under five years old. This study examines the clinical characteristics and treatment outcomes of pediatric COVID-19 pneumonia patients treated with favipiravir in Thailand, aiming to identify associated factors for pneumonia. A retrospective review was performed on pediatric patients aged 1 month to 18 years hospitalized with COVID-19 at Srinagarind Hospital, Khon Kaen University, from 13 January 2020 to 15 November 2021. Data on demographics, clinical symptoms, treatment, and outcomes were collected, and logistic regression analysis was used to identify factors associated with pneumonia. Among 349 hospitalized children, the median age was 8 years, with 51.9% being male. Symptoms included a fever (100%), a cough (74.2%), and a rash (24.9%). COVID-19 pneumonia was diagnosed in 54.7% of the children. Favipiravir was administered as the standard treatment, showing mild adverse effects, including a rash (4.3%) and nausea (2.8%). Monocytosis was significantly associated with COVID-19 pneumonia (aOR 30.85, 95% CI: 9.03-105.41, p < 0.001), with an ROC curve area of 0.77 (95% CI: 0.71-0.83). Pediatric COVID-19 patients typically exhibit mild-to-moderate symptoms, with pneumonia being common in the early pandemic phase. Monocytosis is a significant factor associated with COVID-19 pneumonia. Favipiravir demonstrated mild adverse effects. Further studies are needed to validate these findings across different settings and phases of the pandemic.

Parental Attitudes and Practices regarding Atopic Dermatitis: A Cross-Sectional Study among a Thai Population.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disorder common in children. Successful pediatric AD therapy requires parental assistance. Thus, evaluating parental knowledge, attitudes, and behaviors regarding childhood AD may lead to more educational recommendations to help children control AD in the future. This study examined parents' knowledge, attitudes, and conduct concerning AD in families with and without children with AD. METHOD: The Pediatric Department, Faculty of Medicine, Khon Kaen University, Thailand, conducted a cross-sectional study from June to December 2023. Parents of children who visited the dermatology clinic with or without AD were asked to complete a Google form questionnaire. RESULTS: A total of 372 parents answered a questionnaire about AD pathophysiology, knowledge, attitudes, and practices. The participants were 293 (78.8%) female participants and 79 (21.2%) male participants. The average age was 29.79 (SD 4.91). Most parents (319, 85.8%) did not work in the medical field, and more than half (228 instances, 61.29%) had children diagnosed with AD. CONCLUSIONS: Parents of children with AD understood AD causes and triggers better than parents of children without AD. But, "exposure to furry toys" that may contain dust and allergies and "infection" that may cause AD flare-ups were the most common triggers, regardless of the group. Appropriate information should be supplied because both the parents of children with AD and those of children without AD reported immediate food avoidance without confirmatory testing, which might lead to malnutrition. Clinicians and families handling patients with AD require further education.

Survey of Thai Physicians' Practice in Pediatric Septic Shock.

(1) Background: Sepsis management in children is crucial, especially in emergency services. This study aims to evaluate Thai physicians' knowledge gaps in the emergency management of sepsis in children and to evaluate their adherence to the current sepsis clinical practice guidelines. (2) Methods: This is a cross-sectional survey of Thai physicians' management of septic shock in children. The survey was conducted through online questionnaires from March 2019-April 2019. (3) Results: Of the 366 responders, 362 (98.9%) were completed. Most of the responders were general practitioners (89.2%) and pediatricians (10.8%). The time from positive sepsis screening to being evaluated by physicians within 15 min was reported by 83.9%. The most common choice of fluid resuscitation was normal saline solution (77.3%). The practice of a fluid loading dose (20 mL/kg) consistent with the guidelines was 56.3%. The selection of the first vasoactive agent in warm shock (norepinephrine) and cold shock (epinephrine) according to recommendations in the guidelines was 74.3% and 36.2%, respectively. There was a significant difference between general practitioners and pediatricians in terms of knowledge about initial fluid resuscitation and the optimal vasoactive agent in cold shock (p-value < 0.001). In the multivariate model, factors associated with the guideline-based decision-making of vasoactive agent choice for cold shock were specialist training (pediatrician) and the completion of sepsis management training certification, with adjusted odds ratios (AORs) of 7.81 and 2.96, but working experience greater than ten years was inconsistent with the guideline-based decision-making (AOR 0.14). (4) Conclusions: Thai clinicians were unfamiliar with pediatric sepsis therapy standards, specifically the quantity of early fluid resuscitation and the appropriate vasoactive medications for cold shock. To encourage adherence to the guidelines, we propose a regularly required training course on pediatric sepsis management.

The epidemiology and outcomes of hospitalized drowning in Thai children: a national data analysis 2015-2019.

BACKGROUND: Drowning remains a common cause of death among children. However, the epidemiology and impact of drowning in Thailand was underexplored. This study aimed to analyze the epidemiology and clinical outcomes of pediatric drowning in Thailand and to determine the factors associated with the need for intubation and mortality. METHODS: Data derived from the Thai healthcare delivery system for the period between 2015 and 2019 were used to examine the monthly admissions, mortality rates, length of hospital stay, and the number of patients who received endotracheal intubation. Multivariate logistic regression analysis was employed to identify the risk factors associated with the need for intubation and mortality. RESULTS: Of the 4,911, 58.8% were under six years old, 63.5% were male, and 31.2% were from the Northeastern region. The majority drowned during April, which is the summer season in Thailand. Among these patients, 28.8% required intubation, with the highest proportion found in the 6-<12 years age group (35.9%). The independent risk factors for intubation were metabolic acidosis (adjusted odd ratio [aOR] 9.74; 95% confidence interval [CI] 7.14-13.29; p < 0.001) and pulmonary edema (aOR 5.82; 95%CI 3.92-8.65; p < 0.001). The overall mortality rate due to drowning was 12.6%. Factors significantly associated with mortality included in-hospital cardiac arrest (aOR 4.43; 95%CI 2.78-7.06; p < 0.001), and the presence of drowning-related complications, particularly renal failure (aOR 7.13; 95%CI 3.93-12.94; p < 0.001). CONCLUSION: Drowning admissions and mortality were highest among male children under six years old, occurring mainly during the summer season. Significant factors associated with intubation requirement included metabolic acidosis and pulmonary edema. The mortality was significantly associated with in-hospital cardiac arrest and drowning-related complications, particularly renal failure. TRIAL REGISTRATION: This is an observational study, does not include any intervention, and has therefore not been registered.

Antibodies against SARS-CoV-2 in unvaccinated children hospitalized with COVID-19: An observational cohort study of pre-Omicron and Omicron variants era.

PURPOSE: This study aimed to investigate the antibodies against SARS-CoV-2 in children hospitalized due to COVID-19 during the era of pre-Omicron and Omicron variants. METHODS: This was a retrospective observational study conducted at a tertiary academic medical center in Thailand between June 2021 and August 2022. We collected the data of children aged under 18-year who were hospitalized from SARS-CoV-2 infection. After hospital discharge, we scheduled clinical follow-up 60 to 90 days post-infection clinical follow-up. We measured antibodies against SARS-CoV-2 anti-spike protein receptor-binding domain in the serum during a follow-up visit and compared the mean difference of antibody levels between children infected with COVID-19 during the pre-Omicron and Omicron eras. RESULTS: A total of 119 children enrolled into the study. There were 58 and 61 children hospitalized due to COVID-19 during pre-Omicron and Omicron era, respectively. The median (interquartile range, IQR) of SARS-CoV-2 antibodies in all cases was 206.1 (87.9-424.1) U/mL at follow-up. Children infected during pre-Omicron had SARS-CoV-2 antibody levels at follow-up higher than children infected during Omicron era [mean difference 292.57 U/mL, 95% CI 53.85-531.28, p = 0.017). There was no difference in SARS-CoV-2 antibody levels between the children based on gender, age, co-morbidities, chest radiograph classification, or diagnosis. CONCLUSIONS: The antibodies response to SARS-CoV-2 infection was weaker during the Omicron era than previous variant of concern. Immunization strategies and policies should be implemented in children even if they had been previously infected.

Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study.

(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.

Chest X-ray findings of COVID-19 pneumonia in children: Experiences in a multicenter study in Thailand.

INTRODUCTION: Although chest X-ray is commonly used to diagnose COVID-19 pneumonia, few studies have explored findings in pediatric patients. This study aimed to reveal chest X-ray characteristics in children with COVID-19 pneumonia and compare between non-severe and severe cases. METHODS: This multicenter, nationwide retrospective study included all children aged 0 to 15 years who were admitted to 13 medical facilities throughout Thailand with COVID-19 pneumonia between January 2020 and October 2021. We analyzed the demographics, clinical features, and chest X-ray results of these children, and compared differences between the non-severe and severe groups. RESULTS: During the study period, 1018 children (52% male, median age 5 years) were admitted with COVID-19 pneumonia. Most chest radiographic findings showed bilateral (51%) patchy/ground glass opacities (61%) in the central area (64%). Only 12% of the children exhibited typical classification for COVID-19 pneumonia, whereas 74% of chest radiographs were categorized as indeterminate. Comorbidities including chronic lung diseases [adjusted OR (95%CI): 14.56 (3.80-55.75), P-value <0.001], cardiovascular diseases [adjusted OR (95%CI): 7.54 (1.44-39.48), P-value 0.017], genetic diseases [adjusted OR (95%CI): 28.39 (4.55-177.23), P-value <0.001], clinical dyspnea [adjusted OR (95%CI): 12.13 (5.94-24.77), P-value <0.001], tachypnea [adjusted OR (95%CI): 3.92 (1.79-8.55), P-value 0.001], and bilateral chest X-ray infiltrations [adjusted OR (95%CI): 1.99 (1.05-3.78), P-value 0.036] were factors associated with severe COVID-19 pneumonia. CONCLUSION: Most children with COVID-19 pneumonia had indeterminate chest X-rays according to the previous classification. We suggest using chest X-rays in conjunction with clinical presentation to screen high-risk patients for early detection of COVID-19 pneumonia.

Lumicitabine, an orally administered nucleoside analog, in infants hospitalized with respiratory syncytial virus (RSV) infection: Safety, efficacy, and pharmacokinetic results.

Respiratory syncytial virus (RSV) infection is the leading cause of infant hospitalizations and mortality. Lumicitabine, an oral nucleoside analog was studied for the treatment of RSV. The phase 1b and phase 2b studies reported here assessed the safety, pharmacokinetics, and pharmacodynamics of lumicitabine in infants/neonates hospitalized with RSV. In the phase 1b study, infants (≥1 to ≤12 months) and neonates (<28 days) received a single-ascending or multiple-ascending doses (single loading dose [LD] then 9 maintenance doses [MD] of lumicitabine, or placebo [3:1]). In the phase 2b study, infants/children (28 days to ≤36 months old) received lumicitabine 40/20 mg/kg, 60/40 mg/kg LD/MD twice-daily or placebo (1:1:1) for 5 days. Safety, pharmacokinetics, and efficacy parameters were assessed over 28 days. Lumicitabine was associated with a dose-related increase in the incidence and severity of reversible neutropenia. Plasma levels of ALS-008112, the active nucleoside analog, were dose-proportional with comparable mean exposure levels at the highest doses in both studies. There were no significant differences between the lumicitabine groups and placebo in reducing viral load, time to viral non-detectability, and symptom resolution. No emergent resistance-associated substitutions were observed at the RSV L-gene positions of interest. In summary, lumicitabine was associated with a dose-related increase in the incidence and severity of reversible neutropenia and failed to demonstrate antiviral activity in RSV-infected hospitalized infants. This contrasts with the findings of the previous RSV-A adult challenge study where significant antiviral activity was noted, without incidence of neutropenia. Trial registration ClinicalTrials.gov Identifier: NCT02202356 (phase 1b); NCT03333317 (phase 2b).

Burden of acute lower respiratory infection in children in Thailand in 2010: have we achieved the national target in under-five morbidity and mortality?

BACKGROUND: National reports indicate that morbidity and mortality from pneumonia among Thai children has decreased dramatically since the turn of the millennia; notwithstanding, pneumonia remains the leading cause of admission and death in Thai children under five years of age. OBJECTIVE: To assess the burden and pattern of acute lower respiratory infection in under-fives in Thailand from the health data in 2010. MATERIAL AND METHOD: Information on respiratory infection using the ICD10: J09-J22 was evaluated for the number of OPD visits, admissions, mortality, monthly incidence and co-morbidities of the mortality. RESULTS: 73% of all OPD visits with ALRI were in under-fives: one-fourth of whom required hospitalization. Pneumonia is the leading cause of both admissions and mortality (3.22% and 11.29/100,000 population for this age group, respectively). The highest mortality was in the first year of life (39/100,000). One-fourth of the children (168/639) died within 24 hours of admission and septicemia was the most common co-morbidity. CONCLUSION: The respective morbidity and mortality of pneumonia in under-fives fell far short of national targets. To achieve these targets, many key aspects are needed; such as, strengthening the knowledge of healthcare personnel, the cost-effectiveness researches on the causative organism detection and the expanding coverage of the preventable-vaccine.