Sepsis-related pediatric acute respiratory distress syndrome: A multicenter prospective cohort study.

OBJECTIVES: This study aimed to compare the risk factors and outcomes for organ dysfunction between sepsis-related Pediatric acute respiratory distress syndrome (PARDS) and nonsepsis PARDS. METHODS: We prospective cohort recruited intubated patients with PARDS at four tertiary care centers in Thailand. The baseline characteristics, mechanical ventilation, fluid balance, and clinical outcomes were collected. The primary outcome was organ dysfunction. RESULTS: One hundred and thirty-two mechanically ventilated children with PARDS were included in the study. The median age was 29 months and 53.8% were male. The mortality rate was 22.7% and organ dysfunction was 45.4%. There were 26 (19.7%) and 106 (80.3%) patients who were classified into sepsis-related PARDS and nonsepsis PARDS, respectively. Sepsis-related PARDS patients had a significantly higher incidence of acute kidney injury (30.8% vs. 13.2%, P = 0.041), septic shock (88.5% vs. 32.1%, P < 0.001), organ dysfunction (84.6% vs. 35.8%, P < 0.001), and death (42.3% vs. 17.9%, P = 0.016) than nonsepsis PARDS group. Multivariate analysis adjusted for clinical variables showed that sepsis-related PARDS and percentage of fluid overload were significantly associated with organ dysfunction (odds ratio [OR] 11.414; 95% confidence interval [CI] 1.40892.557, P = 0.023 and OR 1.169; 95% CI 1.0121.352, P = 0.034). CONCLUSIONS: Sepsis-related PARDS patients had more severe illness, organ dysfunction, and mortality than nonsepsis PARDS patients. The higher percentage of fluid overload and presentation of sepsis was the independent risk factor of organ dysfunction in PARDS patients.

Development and validation of the predictive score for pediatric COVID-19 pneumonia: A nationwide, multicenter study.

BACKGROUND: Due to the possibility of asymptomatic pneumonia in children with COVID-19 leading to overexposure to radiation and problems in limited-resource settings, we conducted a nationwide, multi-center study to determine the risk factors of pneumonia in children with COVID-19 in order to create a pediatric pneumonia predictive score, with score validation. METHODS: This was a retrospective cohort study done by chart review of all children aged 0-15 years admitted to 13 medical centers across Thailand during the study period. Univariate and multivariate analyses as well as backward and forward stepwise logistic regression were used to generate a final prediction model of the pneumonia score. Data during the pre-Delta era was used to create a prediction model whilst data from the Delta one was used as a validation cohort. RESULTS: The score development cohort consisted of 1,076 patients in the pre-Delta era, and the validation cohort included 2,856 patients in the Delta one. Four predictors remained after backward and forward stepwise logistic regression: age < 5 years, number of comorbidities, fever, and dyspnea symptoms. The predictive ability of the novel pneumonia score was acceptable with the area under the receiver operating characteristics curve of 0.677 and a well-calibrated goodness-of-fit test (p = 0.098). The positive likelihood ratio for pneumonia was 0.544 (95% confidence interval (CI): 0.491-0.602) in the low-risk category, 1.563 (95% CI: 1.454-1.679) in the moderate, and 4.339 (95% CI: 2.527-7.449) in the high-risk. CONCLUSION: This study created an acceptable clinical prediction model which can aid clinicians in performing an appropriate triage for children with COVID-19.

Spatial Estimation of PM2.5 Exposure and its Association with Asthma Exacerbation: A Prospective Study in Thai Children.

Background: The acceptable fine particulate matter (PM2.5) level in Thailand is double the recommendation of the World Health Organization. It is necessary to have an accurate measure of PM2.5 exposure and its association with health problems in vulnerable groups such as asthma exacerbation in Thai children to urge the Clean Air Act in Thailand, which is currently in the process of revision. Objective: To study the association between PM2.5 exposure and asthma exacerbation in children living in Bangkok Metropolitan Region and Chiang Mai Province. Methods: A pilot prospective observational study was conducted at the Chest and Allergy clinic at Ramathibodi Hospital, Mahidol University, Bangkok and at the Chest Clinic at Nakornping Hospital, Chiang Mai, Thailand, from June 2020 to February 2021. Children with asthma, aged 5-18 years old, were recruited. Respiratory symptoms, including cough, chest tightness, dyspnea or wheezing, peak expiratory flow rate, and asthma exacerbation, were recorded twice daily by caregivers. Estimated average daily PM2.5 exposure levels were calculated using ArcGIS® at exacerbation day, three days before exacerbation (lag day 3), and 7 days before exacerbation (lag day 7). Regression analysis was applied to examine the association between PM2.5 exposure and asthma exacerbation. Findings: Seventy asthmatic patients were enrolled. The median age was 9.7 (IQR 5-18) years old. There were 53 respiratory symptoms, 5 admissions, and 1 intensive care unit admission. Daily PM2.5 levels above 12 mcg/m3 (the US cut-off level for the sensitive group) has higher sensitivity to detect asthma exacerbation compared to Thai cut-off level for the sensitive group (37 mcg/m3) (sensitivity 98.2% vs 32.1%). The average daily PM2.5 level exposure at lag day 3 in the exacerbation vs the non-exacerbation group was 27.5 and 13.6 mcg/m3 (p < 0.01), respectively. The daily PM2.5 level at lag day 3 was also correlated with an acute asthmatic attack (r = 0.62, p < 0.01) with the 0.2 events increasing of asthmatic exacerbation every 10 mcg/m3 of increment of daily PM2.5 level. Conclusions: Our findings suggest that asthmatic children are sensitive to daily PM2.5 levels above 12 mcg/m3. Exposure to high daily PM2.5 levels can lead to asthma exacerbation within three days. Further participant recruitment is needed to emphasize this association and establish the national data.

Knowledge, attitude/perception, and practice related to seasonal influenza vaccination among caregivers of young Thai children: A cross-sectional study.

BACKGROUND: Seasonal influenza vaccination uptake among young children in Thailand is low despite national recommendation for vaccination. We implemented a knowledge, attitude/perception, and practice survey to understand determinants of influenza vaccination in children aged six months to two years. METHODS: Using a cross-sectional design, we interviewed caregivers of 700 children in seven hospitals using a structured questionnaire to collect information on caregivers' and children's demographic characteristics, and caregivers' knowledge of influenza illness and national vaccine recommendation, attitude/perception toward influenza vaccine, and information sources. We verified children's influenza vaccination status against medical records (vaccinated vs. unvaccinated). Logistic regression was used to examine factors independently associated with children receiving influenza vaccination in the 2018 season using the dataset restricted to only children's parents. Variables associated with vaccination at p-value ≤0.20 were included in subsequent multivariable logistic models. Significant independent determinants of children's influenza vaccination and collinearity of covariates were assessed. The final model was constructed using a stepwise backward elimination approach with variables significant at p-value <0.05 retained in the model. RESULTS: During August 2018-February 2019, 700 children's caregivers completed the questionnaire; 61 (9%) were caregivers of vaccinated children. Caregivers of the vaccinated children were statistically more likely to have higher education (61% vs. 38%; p-value<0.01) and to know of influenza illness (93% vs. 76%; p-value = 0.03) than those of the unvaccinated group. Factors associated with children receiving influenza vaccination were identifying healthcare providers as a primary source of information about influenza illness for parents (adjusted odds ratio [aOR], 2.8; 95% confidence interval [CI], 1.3-6.0), parents' strongly agreeing with the national recommendation for influenza vaccination in young children (aOR, 2.9; 95% CI, 1.5-5.9), using health insurance provided by the government or parent's employer for children's doctor visits (aOR, 2.6; 95% CI, 1.1-6.6), and the children's history of receiving influenza vaccination in the 2017 season or earlier (aOR, 3.2; 95% CI, 1.4-7.8). CONCLUSION: The majority of caregivers of children in this study had knowledge of influenza illness and influenza vaccine. Caregivers reported various sources of information regarding influenza illness and the vaccine, but healthcare providers remained the most trusted source. Children's history of influenza vaccination in prior season(s) was the strongest determinant of children being vaccinated for influenza in the current season.

Complementary feeding: Attitudes, knowledge and practices of urban families in northern Thailand.

AIM: Urban families in middle-income countries are currently facing cultural and lifestyle transition. Changing from an agricultural to an industrial society may affect family roles and child-care practices. The present study aims to reveal family attitudes, knowledge and practices focusing on complementary feeding (CF). METHODS: A cross-sectional study was conducted in three Child Health Clinics in Chiang Mai, Thailand. Self-administered questionnaires were given to families caring for healthy infants and children less than 18 months of age during October to November 2016. RESULTS: One-hundred and eight respondents completed questionnaires. The study found different attitudes and knowledge gaps between the respondents who were mothers and other family members ('others'). The 'others' were less likely to value CF as a crucial factor promoting child growth and development. Moreover, they had misperceptions about the benefits of animal-based protein and were less confident in their ability to feed the child properly. Most families reported timely introduction of complementary food, using proper milk products and encouraging age-appropriate feeding methods. However, there were undesirable practices including delaying introduction of animal-based protein, inadequate food diversity, the use of seasoning, feeding premasticated food and offering food as a reward. CONCLUSIONS: These findings suggest that nutritional education should be extended to all caregivers involved in CF to improve the adherence to feeding recommendations.