Feeding and eating disorders among hospitalized children and adolescents in Thailand: A 5-year secondary national database analysis.

AIMS: This study aimed to present national data for children and adolescents requiring hospitalization in Thailand. BACKGROUND: Feeding and eating disorders can cause life-threatening and negative health impacts. In Asia, the prevalence is rising. Data from children and adolescents in Thailand are limited. DESIGN: This study is a retrospective study of the national database. METHODS: Data from the National Health Security Office database on Universal Health Insurance Coverage (2015-2019) of 0-17-year-olds were analysed by diagnosis (anorexia nervosa, bulimia nervosa, vomiting associated with psychological disturbances, other eating disorders and unspecified eating disorders). Descriptive statistics, chi-square test and multinomial logistic regression were used. RESULTS: There were 163 patients, averaging 9.4 ± 5.2 years old, requiring 205 admissions. Most diagnoses showed stable trends, except for a slight decrease in anorexia and unspecified eating disorders. Most admissions were due to unspecified eating disorders and psychogenic vomiting, followed by anorexia nervosa. The overall prevalence was 3.86 per 100 000 admissions. Anorexia had the highest hospital costs and re-admission rates. Anorexia nervosa was most prevalent in early adolescence and females, while bulimia nervosa was most prominent in middle adolescence and had a male predominance. CONCLUSION: Early recognition in clinical practice could increase early detection and improve outcomes.

Exposure to Bisphenol A and Its Analogs among Thai School-Age Children.

Bisphenol F (BPF) and bisphenol S (BPS) have become popular substitutes for bisphenol A (BPA) in the plastic industry due to concerns over BPA's adverse effects. However, there is limited information on children's exposure to these chemicals. This study aims to assess the extent of BPA, BPF, and BPS exposure and determine factors that influence such exposure. A group of Thai children (age 6-13 years, N = 358) were recruited between October 2019 and 2020. Two first-morning voids were collected one week apart. Demographic and exposure-related information was gathered. Urinary concentrations of bisphenols were analyzed by liquid chromatography and tandem mass spectrometry. Correlation between bisphenol concentrations with age, body weight, and sources of bisphenol exposure, was determined using generalized estimating equations with linear model. BPA, BPF, and BPS were detected at 79.6%, 31.0%, and 16.8%, with geometric mean (GM) concentrations of 1.41, 0.013, and 0.014 ng/mL, respectively. Younger children aged <10 years exhibited 1.3-1.6 times higher GM levels of all bisphenols compared to older children. Exposure to food stored in plastic containers was associated with higher levels of BPF and BPS. In conclusion, BPA was the most frequently detected bisphenol in urine samples from Thai children, followed by BPF and BPS.

Serum Cortisol as a Biomarker of Severe Dengue.

Dengue infection presents a wide range of clinical symptoms. Serum cortisol is known as a severity predictor of serious infection but is not yet clearly understood in dengue infection. We aimed to investigate the pattern of cortisol response after dengue infection and evaluate the possibility of using serum cortisol as the biomarker to predict the severity of dengue infection. This prospective study was conducted in Thailand during 2018. Serum cortisol and other laboratory tests were collected at four time points: day 1 at hospital admission, day 3, day of defervescence (DFV) (4-7 days post-fever onset), and day of discharge (DC). The study recruited 265 patients (median age (IQR) 17 (13, 27.5)). Approximately 10% presented severe dengue infection. Serum cortisol levels were highest on the day of admission and day 3. The best cut-off value of serum cortisol level for predicting severe dengue was 18.2 mcg/dL with an AUC of 0.62 (95% CI, 0.51, 0.74). The sensitivity, specificity, PPV and NPV were 65.4, 62.3, 16 and 94%, respectively. When we combined serum cortisol with persistent vomiting and day of fever, the AUC increased to 0.76. In summary, serum cortisol at day of admission was likely to be associated with dengue severity. Further studies may focus on the possibility of using serum cortisol as one of the biomarkers for dengue severity.

Five-Year Trend of Adolescent Hospitalizations and Deaths in Thailand: A Secondary National Data Health Situation Analysis.

Adolescence is a critical phase for achieving human potential, serving as the foundation for later health. In 2010, the major causes of hospital admissions and deaths in Thai adolescents were related to preventable causes, specifically engagement in high-risk behaviors such as unprotected sexual intercourse, substance use and unsafe driving. We retrieved data from 1,761,667 adolescent (10-17 years) hospital admissions and 6362 deaths between 2015 and 2019 from the National Health Security Office database. Trends of hospital admissions and deaths, length of stay and medical expenses by sex, age: early (10-13 years) and middle adolescents (14-17 years), and geographical regions were analyzed by ICD-10 disease group and single diagnosis. Hospital admissions increased in relation to the same age population from 2015 to 2019. Trends of the top 3 diagnoses shifted between disease groups from 2015 to 2019. Pregnancy retreated from the first (17.8%) to the third rank (12.2%), and arthropod-borne viral fevers advanced from the third (13.1%) to the first rank (17.1%). Injury and poisoning remained at the second rank (14.5-14.4%). Females were admitted more than males, but males had significantly longer hospital stays. Early adolescents were admitted less than middle adolescents and their hospital stay was significantly shorter. Trends of the top 3 diagnoses for deaths by disease groups remained stable: injury and poisoning (41.2%), neoplasms (10.2%), and respiratory infections (9.5%). The average direct health care cost utilized on adolescent health care was 3813 million Baht (115.54 million US Dollars) per year. Considering the top 3 disease groups, injury and poisoning had the highest average cost per hospital admission and net cost per year consuming 26.4% of the total cost. Our study highlights the cause of hospital admissions and deaths in Thai adolescents, which are mainly preventable. Adolescent health care will improve with more investment in prevention through policy, service, and education reform.

The attitudes and expectation of caregivers of febrile child receiving medical services: a multicenter survey in Thailand.

BACKGROUND: Most caregivers may visit pediatric outpatient clinics with high concern of fever and improper antipyretic use. However, studies of concern about fever in Asian countries are still limited. OBJECTIVES: This study aimed to explore caregivers' attitudes, management of their child's fever, factors associated with their high concern, and expectation from medical services. METHODS: A cross-sectional 26-item self-administered questionnaire was used to survey caregivers of 1-month to 15-year-old febrile infants/children/teenagers visiting outpatient clinics in 9 government hospitals from July 2018 to August 2019. RESULTS: One thousand two hundred and six caregivers (67% response rate) completed self-administered questionnaire. The median age of the caregivers and the pediatric patients were 34 years (interquartile range [IQR] 28-40) and 3.3 years (IQR 1.8-6.1), respectively. Approximately 70% of them believed that fever could harm a child, resulting in brain damage or death. Also, 2% managed high doses of acetaminophen and overdosed the child. The high level of concern was significantly associated with acetaminophen overdose (P < 0.001, Kruskal-Wallis test). Caregivers of nonhealth care providers and children's history of febrile seizure were factors related to higher score of concern. Most caregivers expected definite diagnosis (70.7%), antipyretic drugs (67.4%), and blood tests (48.9%). CONCLUSION: Caregivers' high concern of fever existed in Thailand. This may lead to unnecessary high doses of antipyretics. In clinical practice, the high concern of fever is a challenge for caregivers and pediatric health care providers. A better understanding of fever and its consequence should be advocated for proper management of the child's fever.

Recurrent hypoglycemic seizure as a presenting symptom of post-TBI hypopituitarism in children: a case report, review and proposed protocol.

OBJECTIVES: Post-traumatic brain injury hypopituitarism is a common unrecognized condition in children after head injury. Due to its similarity of clinical symptoms with those of head trauma, clinical diagnosis of post-TBI hypopituitarism is challenging. To date, there is no standardized screening protocol for children with history of brain injury. This article demonstrates a case of 14-year-old boy with severe head trauma who developed refractory seizures with episodic hypoglycemia and weight loss. We aimed to focus on the prevalence, clinical courses and clinical implementations of each hormonal axis in children with post-traumatic brain injury hypopituitarism. We also aim to raise awareness of this condition to pediatricians in light of enhancing patient care. METHODS: We have searched for original articles, published in English between year 2000 and 2021. There are 20 related articles, authors reviewed all the articles independently. RESULTS: Prevalence of post-traumatic hypopituitarism ranges from 5-57% in children. Growth hormone is the most commonly affected hormone. The highest prevalence is 42.3% at more than 12 months after the brain injury. The symptoms and severity range from asymptomatic to requiring long-term hormonal therapy. Although normalization of pituitary function is demonstrated at various times after the injury, hormone replacement therapy is still required in some patients. CONCLUSIONS: This is the first report that demonstrates a presenting symptom of hypopituitarism mimic traumatic brain symptoms which result in it being overlooked. This case emphasizes the need to develop pituitary function screening protocols for children with TBI. We have proposed our pituitary screening protocol for children with TBI in this article.

Prevalence of skin diseases in school-age children.

BACKGROUND: The prevalence of community-based skin diseases, especially among school-age children, depends on topography, climate, and age of population. OBJECTIVE: We determined the prevalence of skin diseases among community-based primary school-age children and identified demographic characteristics in relation to particular skin conditions. METHODS: This was a cross-sectional descriptive survey study of a subproject school cohort in children aged 5-14 years of 2 community-based primary schools. Demographic data and whole-body skin examination were collected. The association of individual skin conditions was analysed by using bivariate and multivariable binary logistic regression. RESULTS: A total of 556 children were enrolled in this study. Of these, 90.2% had at least 1 skin disease. The most common skin disease was postinflammatory hyperpigmentation (PIH) (58.3%), followed by nevus/mole (40.1%), insect bite reaction (28.0%), acanthosis nigricans (20.0%), acne (13.7%), and pityriasis alba (12.9%). There was an increase of body mass index (BMI) in PIH and acanthosis nigricans with the adjusted odds ratios of 2.01 (95% confidence interval [CI] 1.40-2.87, P < 0.001) and 1.93 (95% CI 1.49-2.49, P < 0.001), respectively. Insect bite reaction was related to PIH with the adjusted odds ratio of 5.66 (95% CI 3.15-10.17, P = 0.001). CONCLUSIONS: The most common skin disease in community-based primary school-age children is PIH which related to acanthosis nigricans and insect bite reaction. A decrease of BMI may lower the risk for PIH and acanthosis nigricans. Education on common skin diseases is recommended for both community-based schools and school-age children.

Anthropometric Markers and Iron Status of 6-12-Year-Old Thai Children: Associations and Predictors.

INTRODUCTION: Obesity may be associated with poor iron status. The objective of this study was to investigate the association between different indices of iron status and anthropometric measurements in Thai children. MATERIALS AND METHODS: Anthropometry (weight, height, waist circumference (WC), and body composition assessed by bioelectrical impedance analysis) and iron indices were measured in 336 Thai children aged 6-12 years. Iron deficiency (ID) was defined using two or more of the following: (1) %transferrin saturation (%Tsat) < 16%; (2) serum ferritin (SF) < 15 µg/mL; and (3) soluble transferrin receptor (sTfR) > 5 mg/L. Iron deficiency anaemia (IDA) was defined as haemoglobin < WHO age cutoff combined with ID. Overweight and obesity were defined as body mass index (BMI) standard deviation score (SDS) ≥ +1 SDS or +2 SDS, respectively (WHO growth reference). RESULTS: BMI SDS was significantly positively correlated with sTfR and SF (sTfR, r: 0.209, p < 0.001; SF, r: 0.214, p < 0.001) and negatively correlated with %Tsat (r: -0.132, p = 0.013). Correlations between WC SDS and %fat mass and each iron marker were similar. The percentage with low SF was significantly lower than that using other individual markers. ID prevalence was not significantly different between normal-weight and overweight/obesity groups although a significantly higher proportion of overweight/obese children had sTfR >5 mg/L. Puberty and menarche were significant predictors of ID (puberty adjusted OR: 2.20, 95% CI: 0.43, 11.25; menarche adjusted OR: 6.11, 95% CI: 1.21, 30.94). CONCLUSION: Greater adiposity was associated with poorer iron status. However, SF may not be a good indicator of iron status in Thai children, particularly in those who are overweight/obese, whereas sTfR merits further investigation.

Adherence to Screening for Anemia in 9-Month-Old Full-Term Infants in Bangkok, Thailand.

OBJECTIVES: To determine adherence to the screening for anemia in 9-month-old full-term infants and factors associated with non-adherence to the screening for anemia. METHODS: A descriptive cross-sectional study was conducted in 9-month-old full-term healthy infants who visited the General Pediatric and Well Child Care Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Demographic data, adherence to the screening, and factors associated with non-adherence to the screening were analyzed using percentage, χ2 test, and bivariate logistic regression. RESULTS: A total of 234 full-term infants, aged 9 months, were included in the study between January and December 2019. The prevalence of adherence to the screening for anemia was 76.1% (95% CI 0.70-0.81). The most common cause of non-adherence to the screening was the waiting time for laboratory results (39.3%). Factors associated with non-adherence to the screening were low education of caregiver (AOR 2.684; 95% CI 1.451-4.966), low socio-economic status (AOR 2.26; 95% CI 1.568-3.258), and inadequate complementary food (AOR 1.961; 95% CI 1.107-3.473). CONCLUSION: The most common cause of non-adherence to the screening for anemia is the waiting time for laboratory results. Pediatricians and general practitioners should ensure the importance of anemia screening in infants and plan on anemia screening with parents.

A case of PHACE syndrome with growth hormone deficiency and abnormal thyroid functions.

Background PHACE syndrome is a rare vascular neurocutaneous disorder characterized by posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies and eye anomalies. Growth hormone deficiency (GHD) has been infrequently described. Case presentation We report a girl with PHACE syndrome. Endocrine abnormalities including abnormal thyroid functions and GHD have recently been described in similar cases. Conclusions This case suggests the necessity to screen pituitary functions in all patients with PHACE syndrome with abnormal hypothalamus and pituitary (HP) anatomy. Likewise, growth parameters and thyroid function test (TFT) should be monitored in all patients with PHACE syndrome at regular intervals.

Endocrine manifestations of PHACE syndrome.

PHACE syndrome is an uncommon disorder of posterior fossa anomalies, cervicofacial infantile hemangiomas, arterial anomalies, cardiac defects, eye anomalies, and midline/ventral defects. Endocrine abnormalities including hypopituitarism and ectopic thyroid were rarely described. In this article we review occurrence, onset, presenting symptoms, hormonal treatments and outcomes of all endocrine abnormalities in PHACE syndrome. Eleven of 20 (55%) had hypothalamic-pituitary dysfunction and 10 of 20 (50%) had thyroid dysgenesis. A thorough understanding of the endocrine manifestations is important for clinicians to early identify endocrine involvement in PHACE and develop plans for monitoring and treatment of its complications.